Basic Information
| Provider Information | |||||||||
| NPI: | 1437239605 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KIM | ||||||||
| FirstName: | HOWARD | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 812 AVIS DR | ||||||||
| Address2: | |||||||||
| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481089649 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8006387564 | ||||||||
| FaxNumber: | 8666342766 | ||||||||
| Practice Location | |||||||||
| Address1: | 999 CORPORATE DR STE 100 | ||||||||
| Address2: | |||||||||
| City: | LADERA RANCH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926942149 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8006387564 | ||||||||
| FaxNumber: | 8666342766 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/16/2006 | ||||||||
| LastUpdateDate: | 12/17/2021 | ||||||||
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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 | 2084N0400X | 000000G86646 | CA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
No ID Information.