Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | A146880 | CA |
NPI | 1013398866 |
---|---|
Provider Name | Robert Kim |
First Address | Laguna Hills, CA 92654-3493 |
Second Address | Laguna Hills, CA 92653-7625 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2015 |
Last Update Date | 25/08/2021 |