Organization
JOHN HWAN KIM EVERGREEN MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN KIM (PRESIDENT)
(626) 831-1149
Entity
Organization
Contact information
Practice address
18555 FARJARDO STREET, ROWLAND HEIGHTS, CA 91748-4634
(626) 831-1149
Mailing address
18555 FARJARDO STREET, ROWLAND HEIGHTS, CA 91748-4634
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
PT14527
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
WPT14527A
PPIN
CA
Enumeration date
08/09/2006
Last updated
08/22/2020
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