Provider Demographics
NPI:1063421923
Name:KIM, NEUNG SOO (MD)
Entity type:Individual
Prefix:DR
First Name:NEUNG
Middle Name:SOO
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:25470 MEDICAL CENTER DR
Mailing Address - Street 2:206
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-4900
Mailing Address - Country:US
Mailing Address - Phone:951-973-7380
Mailing Address - Fax:951-973-7389
Practice Address - Street 1:900 S MAIN ST
Practice Address - Street 2:SUITE 111
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882-3401
Practice Address - Country:US
Practice Address - Phone:951-973-7380
Practice Address - Fax:951-973-7389
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2008-02-27
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Provider Licenses
StateLicense IDTaxonomies
CAA373492085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C402870Medicare ID - Type Unspecified