Provider Demographics
NPI:1427073402
Name:KIM, JOO R (MD)
Entity type:Individual
Prefix:DR
First Name:JOO
Middle Name:R
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2621 S BRISTOL ST STE 104
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704-5718
Mailing Address - Country:US
Mailing Address - Phone:714-662-1746
Mailing Address - Fax:714-662-1748
Practice Address - Street 1:2621 S BRISTOL ST STE 104
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-5718
Practice Address - Country:US
Practice Address - Phone:714-662-1746
Practice Address - Fax:714-662-1748
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA367570208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics