Provider Demographics
NPI:1992762769
Name:KIM, JIM C (MD)
Entity type:Individual
Prefix:
First Name:JIM
Middle Name:C
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2203 17TH ST
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-3634
Mailing Address - Country:US
Mailing Address - Phone:661-716-0333
Mailing Address - Fax:661-716-1288
Practice Address - Street 1:2203 17TH ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-3634
Practice Address - Country:US
Practice Address - Phone:661-716-0333
Practice Address - Fax:661-716-1288
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA067383207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00370464OtherMCR RAILROAD PROVIDER #
CA00A673831Medicare PIN
H58369Medicare UPIN