Individual
DR. SAMUEL C. KIM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
555 N 13TH AVE, UPLAND, CA 91786-4904
(909) 982-8846
(909) 949-3967
Mailing address
555 N 13TH AVE, UPLAND, CA 91786-4904
(909) 982-8846
(909) 949-3967
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
0101257811
VA
207W00000X
Ophthalmology Physician
MD042959
DC
207WX0107X
Retina Specialist (Ophthalmology) Physician
Primary
A123812
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
OH
Other
Enumeration date
04/20/2011
Last updated
06/24/2020
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