Individual
KELVIN KIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
STUDENT
Contact information
Practice address
14642 NEWPORT AVE STE 105, TUSTIN, CA 92780-6058
(949) 690-2433
Mailing address
14642 NEWPORT AVE STE 105, TUSTIN, CA 92780-6058
(949) 690-2433
Taxonomy
Speciality
Code
Description
License number
State
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
195258
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/26/2018
Last updated
10/21/2024
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