Provider Demographics
NPI:1992264964
Name:KIM, IRIS (MD)
Entity type:Individual
Prefix:
First Name:IRIS
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:385 S MANCHESTER AVE UNIT 1105
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-3242
Mailing Address - Country:US
Mailing Address - Phone:808-391-4258
Mailing Address - Fax:
Practice Address - Street 1:3816 WOODRUFF AVE STE 209
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90808-2145
Practice Address - Country:US
Practice Address - Phone:562-496-4749
Practice Address - Fax:562-429-3329
Is Sole Proprietor?:No
Enumeration Date:2019-03-18
Last Update Date:2025-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1992264964208000000X
390200000X
CAA180447207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program