| Dong S. Kim, M.d., Inc | |
|
11441 Heacock St Ste. F Moreno Valley CA 92557-7907 | |
| (951) 243-8000 | |
| (951) 243-9707 |
| Full Name | Dong S. Kim, M.d., Inc |
|---|---|
| Speciality | Internal Medicine |
| Location | 11441 Heacock St, Moreno Valley, California |
| Authorized Official Name and Position | Dong Soo Kim (OWNER) |
| Authorized Official Contact | 9512438000 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dong S. Kim, M.d., Inc 11441 Heacock St Ste. F Moreno Valley CA 92557-7907 Ph: (951) 243-8000 | Dong S. Kim, M.d., Inc 11441 Heacock St Ste. F Moreno Valley CA 92557-7907 Ph: (951) 243-8000 |
| NPI Number | 1013027465 |
|---|---|
| Provider Enumeration Date | 08/30/2006 |
| Last Update Date | 06/26/2015 |
| Medicare PECOS PAC ID | 9436208402 |
|---|---|
| Medicare Enrollment ID | O20090521000351 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013027465 | NPI | - | NPPES |
| 1013027465 | Medicaid | CA | |
| A48273 | Other | CA | LICENCE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | A48273 (California) | Primary |
| Provider Name | Dong Kim |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1942267992 PECOS PAC ID: 0446309413 Enrollment ID: I20090521000342 |
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