# JERRY KIM MD INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1093452278
- **Authorized official:** JERRY J KIM (OWNER)
- **Authorized official phone:** (818) 913-2393

## Contact information

- **Practice address:** 350 VINTON AVE STE 202, POMONA, CA 91767-3000
- **Practice address phone:** (909) 973-1148
- **Practice address fax:** (909) 363-4954
- **Mailing address:** 2625 ROADRUNNER DR, LA VERNE, CA 91750-2350

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208600000X | Surgery Physician | — | NULL | — |
| 208600000X | Surgery Physician | — | — | — |
| 2086S0129X | Vascular Surgery Physician | — | NULL | Yes |
| 2086S0129X | Vascular Surgery Physician | — | — | Yes |

## Other

- **Enumeration date:** 05/18/2022
- **Last updated:** 08/01/2023