Individual
JISANG KIM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2 W FERN AVE, REDLANDS, CA 92373-5916
(909) 793-3311
Mailing address
PO BOX 35380, LAS VEGAS, NV 89133-5380
(702) 579-3203
Taxonomy
Speciality
Code
Description
License number
State
208M00000X
Hospitalist Physician
Primary
A123476
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
08/04/2011
Last updated
12/27/2025
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