Provider Demographics
NPI:1053419176
Name:KIM, JONG GUHN (MD,)
Entity type:Individual
Prefix:MR
First Name:JONG
Middle Name:GUHN
Last Name:KIM
Suffix:
Gender:M
Credentials:MD,
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Mailing Address - Street 1:414 S PROSPECTORS RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-1615
Mailing Address - Country:US
Mailing Address - Phone:909-860-0606
Mailing Address - Fax:909-860-6161
Practice Address - Street 1:414 S PROSPECTORS RD
Practice Address - Street 2:SUITE B
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91765-1615
Practice Address - Country:US
Practice Address - Phone:909-860-0606
Practice Address - Fax:909-860-6161
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2017-12-20
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Provider Licenses
StateLicense IDTaxonomies
CA953677780207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6169716Medicaid
CAA32816Medicare PIN