Provider Demographics
NPI:1699096784
Name:KIM, MICHAEL JEVIN (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JEVIN
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:101 THE CITY DR S
Mailing Address - Street 2:ROUTE 140
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-3201
Mailing Address - Country:US
Mailing Address - Phone:714-456-2216
Mailing Address - Fax:714-456-7864
Practice Address - Street 1:101 THE CITY DR S
Practice Address - Street 2:ROUTE 140
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3201
Practice Address - Country:US
Practice Address - Phone:714-456-2216
Practice Address - Fax:714-456-7864
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-12
Last Update Date:2010-06-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA1018802085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology