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Organization
JERRY KIM MD INC
Active
Organization
JERRY KIM MD INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JERRY J KIM (OWNER)
(818) 913-2393
Entity
Organization
Contact information
Practice address
350 VINTON AVE STE 202, POMONA, CA 91767-3000
(909) 973-1148
(909) 363-4954
Mailing address
2625 ROADRUNNER DR, LA VERNE, CA 91750-2350
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
—
NULL
208600000X
Surgery Physician
—
—
2086S0129X
Vascular Surgery Physician
Primary
—
NULL
2086S0129X
Vascular Surgery Physician
Primary
—
—
Other
Enumeration date
05/18/2022
Last updated
08/01/2023
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