Individual
KWAN SOO KIM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
24261 PAULSON DR., LOMA LINDA, CA 92354-4873
(909) 796-5251
Mailing address
24261 PAULSON DR., LOMA LINDA, CA 92354
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
CFE52187
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1082379
—
MI
Enumeration date
08/17/2011
Last updated
08/17/2011
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