Basic Information
| Provider Information | |||||||||
| NPI: | 1003886698 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KIM | ||||||||
| FirstName: | STEVEN | ||||||||
| MiddleName: | WOONG | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2151 N HARBOR BLVD STE 3200 | ||||||||
| Address2: | |||||||||
| City: | FULLERTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928353826 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7144465900 | ||||||||
| FaxNumber: | 7144465800 | ||||||||
| Practice Location | |||||||||
| Address1: | 2151 N HARBOR BLVD STE 3200 | ||||||||
| Address2: | |||||||||
| City: | FULLERTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928353826 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7144465900 | ||||||||
| FaxNumber: | 7144465800 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/25/2006 | ||||||||
| LastUpdateDate: | 10/11/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | 200000491 | NC | N | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | 207RH0003X | C52751 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 006018491 | 05 | VA | MEDICAID | 89126K7 | 05 | NC | MEDICAID |