Organization
CHARLES KIM MD INC
Active
Other names
Luzwave Medical Group
Organization subpart
No
Provider details
NPI number
Authorized official
LINDA MACK (ADMINISTRATOR/DELEGATED OFFICIAL)
(951) 801-5566
Entity
Organization
Contact information
Practice address
14642 NEWPORT AVE STE 105, TUSTIN, CA 92780-6058
(951) 801-5566
(714) 486-2309
Mailing address
14642 NEWPORT AVE STE 105, TUSTIN, CA 92780-6058
(951) 801-5566
(714) 486-2309
Taxonomy
Speciality
Code
Description
License number
State
207QG0300X
Geriatric Medicine (Family Medicine) Physician
Primary
—
—
Other
Enumeration date
12/19/2019
Last updated
12/19/2019
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