Organization
JIENSUP KIM, M.D. INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JIENSUP KIM M.D. (PRESIDENT)
(909) 370-0300
Entity
Organization
Contact information
Practice address
10431 COMMERCE ST, SUITE A, REDLANDS, CA 92374-2833
(909) 796-7700
(909) 796-4383
Mailing address
PO BOX 71, REDLANDS, CA 92373-0021
(909) 370-0300
(909) 370-0303
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
G75806
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1639131154
INDIVIDUAL NPI
CA
Enumeration date
11/13/2006
Last updated
03/24/2011
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