JERRY KIM MD INC – NPI #1093452278
Surgery

A surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart.

JERRY KIM MD INC is a surgeon located in POMONA, CA. NPPES has assigned the NPI number 1093452278 to JERRY KIM MD INC on May 18, 2022. It is a Type-2 NPI, indicating this NPI number is associated with an organization. With multiple taxonomy codes selected, the primary taxonomy selected by this provider is 2086S0129X from the Health Care Provider Taxonomy code set, which is classified as Surgery, specializing in Vascular Surgery

The NPI profile was previously updated about 3 years ago on Aug 01, 2023. Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for JERRY KIM MD INC below.

NPI Profile for
JERRY KIM MD INC

NPI Number
1093452278
Enumeration Date

(more than 4 years ago)
Entity Type
Type-2  Organization
Organization health care providers may have a single employee or thousands of employees. An example is an incorporated individual who is an organization's only employee.
Legal Name
JERRY KIM MD INC
Primary 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
Phone: Fax:
Organization Subpart
No
Authorized Official
JERRY KIM
OWNER
Phone: (818) 913-2393
Updated
Certification Date
Aug 01, 2023

Note: NPPES allows providers to attest to the accuracy of their NPI data. When a provider request any change to the NPI record, they will be able to attest to their changed NPI data, resulting in an updated certification date.

Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
2086S0129X
- Surgery / Vascular Surgery (Primary)
208600000X
- Surgery

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.