Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | A86558 | CA |
NPI | 1437198678 |
---|---|
Provider Name | Michael K Kim |
First Address | Los Alamitos, CA 90720-3338 |
Second Address | Los Alamitos, CA 90720-3338 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2006 |
Last Update Date | 18/04/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H29586 | (02) |