1659496339 NPI number — DR. JEFFREY DAVID KIM M.D.

Table of content: DR. JEFFREY DAVID KIM M.D. (NPI 1659496339)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659496339 NPI number — DR. JEFFREY DAVID KIM M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KIM
Provider First Name:
JEFFREY
Provider Middle Name:
DAVID
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1659496339
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/21/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
470 S PATTERSON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANTA BARBARA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93111-2404
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4806 CARPINTERIA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARPINTERIA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93013-1935
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-566-5080
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/20/2007

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: 207Q00000X , with the licence number:  C161734 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207Q00000X , with the licence number: 5029 , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: MD45685 , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".




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