Basic Information
| Provider Information | |||||||||
| NPI: | 1396792677 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KIM | ||||||||
| FirstName: | HYONG | ||||||||
| MiddleName: | J. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12900 PARK PLAZA DR STE 150 | ||||||||
| Address2: | ATTENTION: MAGGIE NOLES MS 6165 | ||||||||
| City: | CERRITOS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 907039329 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5627414461 | ||||||||
| FaxNumber: | 5626222971 | ||||||||
| Practice Location | |||||||||
| Address1: | 10000 LAKEWOOD BLVD | ||||||||
| Address2: | ATTENTION MAGGIE NOLES MS 6165 | ||||||||
| City: | DOWNEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902404020 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5628623684 | ||||||||
| FaxNumber: | 5628627145 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/30/2006 | ||||||||
| LastUpdateDate: | 03/29/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | A63995 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 075479 | 01 | HEALTH NET ID # | OTHER | 00A639950 | 01 | BLUE SHIELD ID # | OTHER | 110190205 | 01 | RAILROAD | OTHER | 00A639950 | 05 | CA | MEDICAID |