Provider Demographics
NPI:1174606511
Name:WESTERN PATHOLOGY MEDICAL ASSOC INC
Entity type:Organization
Organization Name:WESTERN PATHOLOGY MEDICAL ASSOC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HUN
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-953-3381
Mailing Address - Street 1:5856 CORPORATE AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CYPRESS
Mailing Address - State:CA
Mailing Address - Zip Code:90630-4754
Mailing Address - Country:US
Mailing Address - Phone:714-236-4000
Mailing Address - Fax:714-236-4006
Practice Address - Street 1:1001 N TUSTIN AVE
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-3502
Practice Address - Country:US
Practice Address - Phone:714-953-3381
Practice Address - Fax:714-953-3541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-21
Last Update Date:2015-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ01419ZOtherBLUE SHIELD
CAZZZ59624ZOtherBLUE SHIELD
CAGR0085941Medicaid
CAGR0085940Medicaid
CAGR0085941Medicaid
CAZZZ59624ZOtherBLUE SHIELD