Kwang Sook Kim, M.D.

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

A37552 Issued in CA

Practice address

9636 Garden Grove Blvd # 16
Garden Grove, CA 92844-1530

Phone

(714) 290-1657

Fax

(562) 404-4323

NPI assigned

Sep 27, 2006

Last updated

Sep 30, 2011By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1159315200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1317340800000",
    "number": "1285725051",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9636 GARDEN GROVE BLVD # 16",
            "city": "GARDEN GROVE",
            "state": "CA",
            "postal_code": "928441530",
            "telephone_number": "714-290-1657",
            "fax_number": "562-404-4323"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9636 GARDEN GROVE BLVD # 16",
            "city": "GARDEN GROVE",
            "state": "CA",
            "postal_code": "928441530",
            "telephone_number": "714-290-1657",
            "fax_number": "562-404-4323"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "KWANG",
        "middle_name": "SOOK",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-09-27",
        "last_updated": "2011-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "CA",
            "license": "A37552",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A375520",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ju Yun Kim, L.AC.
• Junghee Jason Kim, L.AC
• Justin Joon-Seoh Kim, DDS
• Kaidi He Kim, MD
• Kathy Kim, PHARM.D.
• Lisa Kim
• Lisa Ann Kim
• Lois Kim
• Mi Jung Kim
• Michael Hwangsuk Kim, DDS.

• General Practice Physician in Garden Grove, CA
• Providers in Garden Grove, CA by specialty
• General Practice Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.