Charles Kim MD Inc

Primary specialty

Geriatric Medicine (Family Medicine) PhysicianTaxonomy code 207QG0300X

Legal business name

CHARLES KIM MD INC

Doing business as

Luzwave Medical Group

Practice address

14642 Newport Ave Ste 105
Tustin, CA 92780-6058

Phone

(951) 801-5566

Fax

(714) 486-2309

NPI assigned

Dec 19, 2019

Last updated

Dec 19, 2019By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Linda Mack

Title

Administrator/Delegated Official

Phone

(951) 801-5566

Specialties & licenses 1

Addresses

Other names 1

• Luzwave Medical Group Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Charles Chol Bae Kim, MD

  • Adult Medicine Physician
  • Tustin, CA
  • NPI 1225564818

  Multi-Specialty

  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1576713600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1576713600000",
    "number": "1063050193",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14642 NEWPORT AVE STE 105",
            "city": "TUSTIN",
            "state": "CA",
            "postal_code": "927806058",
            "telephone_number": "951-801-5566",
            "fax_number": "714-486-2309"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14642 NEWPORT AVE STE 105",
            "city": "TUSTIN",
            "state": "CA",
            "postal_code": "927806058",
            "telephone_number": "951-801-5566",
            "fax_number": "714-486-2309"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHARLES KIM MD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-12-19",
        "last_updated": "2019-12-19",
        "certification_date": "2019-12-19",
        "status": "A",
        "authorized_official_last_name": "MACK",
        "authorized_official_first_name": "LINDA",
        "authorized_official_title_or_position": "ADMINISTRATOR/DELEGATED OFFICIAL",
        "authorized_official_telephone_number": "951-801-5566"
    },
    "taxonomies": [
        {
            "code": "207QG0300X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Luzwave Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Elizabeth F Chapman, MSW
• Jeanine Dee Chapman, SLP
• Molly Chapman, CPNP
• Alexa Charbonneau
• Charles K. Oh, MD Inc.
• Artaporn Chatkoo
• Ana Chavez
• Yasmin Chavez
• Devon Chazan
• Sara Danielle Chee

• Geriatric Medicine (Family Medicine) Physician in Tustin, CA
• Providers in Tustin, CA by specialty
• Geriatric Medicine (Family Medicine) Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.