Jong G Kim M.D. a Medical Corporation

Primary specialty

SpecialistTaxonomy code 174400000X

License

A32816 Issued in CA

Legal business name

JONG G KIM M.D. A MEDICAL CORPORATION

Practice address

414 S Prospectors Rd
Suite B
Diamond Bar, CA 91765-1615

Phone

(909) 860-0606

Fax

(909) 860-6161

NPI assigned

Dec 13, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Jong G. Kim, M.D.

Title

Physician

Phone

(909) 860-0606

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1165968000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1513814400000",
    "number": "1225199201",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "414 S PROSPECTORS RD",
            "address_2": "SUITE B",
            "city": "DIAMOND BAR",
            "state": "CA",
            "postal_code": "917651615",
            "telephone_number": "909-860-0606",
            "fax_number": "909-860-6161"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "414 S PROSPECTORS RD",
            "address_2": "SUITE B",
            "city": "DIAMOND BAR",
            "state": "CA",
            "postal_code": "917651615",
            "telephone_number": "909-860-0606",
            "fax_number": "909-860-6161"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JONG G KIM M.D. A MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-13",
        "last_updated": "2017-12-21",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "JONG",
        "authorized_official_middle_name": "G.",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "909-860-0606",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "CA",
            "license": "A32816",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6169716",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Diamond Bar, CA
• Providers in Diamond Bar, CA by specialty
• Specialist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2017; 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.