1699948265 NPI number — WONHA KIM M.D., M.P.H.

Table of content: WONHA KIM M.D., M.P.H. (NPI 1699948265)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699948265 NPI number — WONHA KIM M.D., M.P.H.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KIM
Provider First Name:
WONHA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D., M.P.H.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699948265
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/01/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11175 CAMPUS ST
Provider Second Line Business Mailing Address:
COLEMAN PAVILLION ROOM A-1121
Provider Business Mailing Address City Name:
LOMA LINDA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92350-1700
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
443-812-5287
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
25845 BARTON RD
Provider Second Line Business Practice Location Address:
SUITE F
Provider Business Practice Location Address City Name:
LOMA LINDA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92354-3899
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-812-5287
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/03/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  A127117 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)