Individual ProviderMi Song KimEmergency MedicineAllopathic & Osteopathic PhysiciansPractice Address4445 Magnolia Ave, Riverside, CA 92501-4135(951) 788-3000PECOS EnrollmentBased on the most recent information from CMS, provider Mi Song Kim is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1972182640Provider TypeIndividualFull NameKim, Mi SongCredentialMDGenderFemaleSole ProprietorNoEnumeration Date4/7/2021Last Updated9/23/2024Contact InformationPractice LocationPractice Address4445 Magnolia Ave, Riverside, CA 92501-4135Phone(951) 788-3000FaxUnlisted FaxMailing LocationMailing Address2317 W Broadway Unit 98, Anaheim, CA 92804-2593PhoneUnlisted PhoneFaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode207P00000XPrimaryDescriptionEmergency MedicineAllopathic & Osteopathic PhysiciansLicenseA193015CaliforniaCode390200000XDescriptionStudent in an Organized Health Care Education/Training ProgramStudent, Health CareLicenseUnlisted Issuer