Provider Demographics
NPI:1699948265
Name:KIM, WONHA (MD, MPH)
Entity type:Individual
Prefix:
First Name:WONHA
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11175 CAMPUS ST
Mailing Address - Street 2:COLEMAN PAVILLION ROOM A-1121
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92350-1700
Mailing Address - Country:US
Mailing Address - Phone:443-812-5287
Mailing Address - Fax:
Practice Address - Street 1:25845 BARTON RD
Practice Address - Street 2:SUITE F
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-3899
Practice Address - Country:US
Practice Address - Phone:443-812-5287
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-03
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA127117208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics