Provider Demographics
NPI:1114230315
Name:JAY & SUN KIM PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:JAY & SUN KIM PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOO
Authorized Official - Middle Name:R
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:661-831-1100
Mailing Address - Street 1:9905 BACE AVE
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93307-6211
Mailing Address - Country:US
Mailing Address - Phone:661-831-1100
Mailing Address - Fax:661-831-8279
Practice Address - Street 1:9905 BACE AVE
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93307-6211
Practice Address - Country:US
Practice Address - Phone:661-831-1100
Practice Address - Fax:661-831-8279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-16
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00A380850302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A380850Medicaid
CA00A380850Medicaid
CA00A380850Medicare Oscar/Certification