Provider Demographics
NPI:1316665524
Name:MICHAEL J KIM DPM PC
Entity type:Organization
Organization Name:MICHAEL J KIM DPM PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LUCIA
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-317-4098
Mailing Address - Street 1:23141 VERDUGO DR STE 201
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-1341
Mailing Address - Country:US
Mailing Address - Phone:949-215-5055
Mailing Address - Fax:949-326-5099
Practice Address - Street 1:9353 FAIRWAY VIEW PL STE 100
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-0961
Practice Address - Country:US
Practice Address - Phone:909-858-2772
Practice Address - Fax:909-300-6324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-15
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric