# JAE M KIM MD

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

## Provider details

- **NPI number:** 1558530428
- **Authorized official:** JAMES WANG (BILLER)
- **Authorized official phone:** (626) 536-7534

## Contact information

- **Practice address:** 1433 W MERCED AVE STE 217, WEST COVINA, CA 91790-3402
- **Practice address phone:** (626) 917-1924
- **Practice address fax:** (626) 337-9434
- **Mailing address:** 1433 W MERCED AVE STE 217, WEST COVINA, CA 91790-3402
- **Mailing address phone:** (626) 917-1924
- **Mailing address fax:** (626) 337-9434

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | A38835 | CA | Yes |

## Other

- **Enumeration date:** 02/26/2008
- **Last updated:** 02/26/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 00A383350 | — | CA |