Provider Demographics
NPI:1154355857
Name:KIM, JANET M (MD)
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:M
Last Name:KIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9850 GENESEE AVE
Mailing Address - Street 2:SUITE 420
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-1224
Mailing Address - Country:US
Mailing Address - Phone:858-457-3270
Mailing Address - Fax:858-457-5723
Practice Address - Street 1:9850 GENESEE AVE
Practice Address - Street 2:SUITE 420
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1224
Practice Address - Country:US
Practice Address - Phone:858-457-3270
Practice Address - Fax:858-457-5723
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA65775174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG96969Medicare UPIN
CAWA65775BMedicare ID - Type Unspecified