Provider Demographics
NPI:1023805587
Name:KIM, CALVIN DONGJOON
Entity type:Individual
Prefix:
First Name:CALVIN
Middle Name:DONGJOON
Last Name:KIM
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10759 ARABELLA PL
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-8019
Mailing Address - Country:US
Mailing Address - Phone:562-396-3452
Mailing Address - Fax:
Practice Address - Street 1:10759 ARABELLA PL
Practice Address - Street 2:
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-8019
Practice Address - Country:US
Practice Address - Phone:562-396-3452
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-21
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program