Individual
WAYNE W KIM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
12362 BEACH BLVD STE 10, STANTON, CA 90680-3944
(714) 248-9500
(714) 622-4943
Mailing address
12362 BEACH BLVD STE 10, STANTON, CA 90680-3944
(714) 248-9500
(714) 622-4943
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
OP00001562
WA
207QA0401X
Addiction Medicine (Family Medicine) Physician
OP00001562
WA
261QC1500X
Community Health Clinic/Center
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
CA
Enumeration date
08/08/2006
Last updated
09/14/2022
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