Kim, Wayne W

Kim, Wayne W is an sole proprietor health care provider with primary practice located at 12362 Beach Blvd Ste 10 , Stanton CA 90680-3944. He recently has 4 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Family Medicine, Allopathic & Osteopathic Physicians / Addiction Medicine, Ambulatory Health Care Facilities / Community Health, Ambulatory Health Care Facilities / Federally Qualified Health Center (FQHC). Ambulatory Health Care Facilities / Federally Qualified Health Center (FQHC) is his primary health care specialty. Kim, Wayne W can be contacted via phone (714) 248-9500.

Contact Information

Primary practice address
12362 Beach Blvd Ste 10 Stanton CA 90680-3944
Phone: (714) 248-9500
Fax: (714) 622-4943
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X OP00001562 Washington
Allopathic & Osteopathic Physicians / Addiction Medicine 207QA0401X OP00001562 Washington
Ambulatory Health Care Facilities / Community Health 261QC1500X
Ambulatory Health Care Facilities / Federally Qualified Health Center (FQHC) 261QF0400X

Profile Details

NPI number 1619987054
LBN Legal business name Kim, Wayne W
Credentials Doctor of Osteopathy (DO)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Aug 8th, 2006
Last updated Sep 14th, 2022 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1619987054 NPPES
California MEDICAID PENDING

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