Provider Demographics
NPI:1194993923
Name:KIM, KRISTINA JIN (DO)
Entity type:Individual
Prefix:DR
First Name:KRISTINA
Middle Name:JIN
Last Name:KIM
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1440 MILITARY W
Mailing Address - Street 2:
Mailing Address - City:BENICIA
Mailing Address - State:CA
Mailing Address - Zip Code:94510-2451
Mailing Address - Country:US
Mailing Address - Phone:707-745-0711
Mailing Address - Fax:
Practice Address - Street 1:1440 MILITARY W
Practice Address - Street 2:
Practice Address - City:BENICIA
Practice Address - State:CA
Practice Address - Zip Code:94510-2451
Practice Address - Country:US
Practice Address - Phone:707-745-0711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-14
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A10311207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine