Organization · NPI-2

Jerry Kim MD INC

· Pomona, CA

NPI number1093452278
StatusActive
Last updated in NPPESAug 1, 2023

Details

NPI
1093452278
Entity type
Organization (NPI-2)
Legal business name
Jerry Kim MD INC
Organization subpart
No
Enumeration date
May 18, 2022
Certification date
Aug 1, 2023
Last updated
Aug 1, 2023

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
2086S0129X ––Yes
208600000X Surgery––

Practice location

350 Vinton Ave Ste 202
Pomona, CA 91767-3000

Phone 909-973-1148 · Fax 909-363-4954

Mailing address

2625 Roadrunner Dr
La Verne, CA 91750-2350

Authorized official

Jerry J Kim
Owner
8189132393

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