Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RH0003X | Hematology & Oncology | 200000491 | NC |
Y | 207RH0003X | Hematology & Oncology | C52751 | CA |
NPI | 1003886698 |
---|---|
Provider Name | Steven Woong Kim |
First Address | Fullerton, CA 92835-3826 |
Second Address | Fullerton, CA 92835-3826 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2006 |
Last Update Date | 19/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
006018491 | (05) | VA |
89126K7 | (05) | NC |
H14617 | (02) | NC |