Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207VE0102X | Reproductive Endocrinologist | 04-32372 | KS |
Y | 207VE0102X | Reproductive Endocrinologist | A44647 | CA |
N | 207VG0400X | Gynecologist | 04-32372 | KS |
NPI | 1053415281 |
---|---|
Provider Name | Dr. Se-Ung Samuel Kim |
First Address | Fullerton, CA 92835-2626 |
Second Address | Fullerton, CA 92835-2626 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/09/2006 |
Last Update Date | 18/09/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200424060A | (05) | KS |
E60509 | (02) |