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Individual

CHARLES CHOL BAE KIM

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
14642 NEWPORT AVE STE 105, TUSTIN, CA 92780-6058
(714) 831-1112
(714) 486-2309
Mailing address
1200 W MOHAVE RD, PARKER, AZ 85344-6349
(928) 669-7380

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
54481
AZ
207QA0505X
Adult Medicine Physician
Primary
C129160
CA
207QG0300X
Geriatric Medicine (Family Medicine) Physician
C-129160
CA

Other

Enumeration date
05/03/2017
Last updated
10/13/2021
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