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Licensing details for: A 194912

Name: KIM, JEONG HWAN JAKE

License Type: Physician and Surgeon A

Primary Status: License Renewed & Current Primary Status Definition

School Name: University of Queensland Ochsner Clinical School

Graduation Year: 2020

Address of Record

215 W Janss Rd
THOUSAND OAKS CA 91360-1847
VENTURA county
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Issuance Date

March 21, 2024

Expiration Date

May 31, 2026

Current Date / Time

April 3, 2026
3:40:29 AM

Public Record Actions

Public Documents

License Relationships

Postgraduate Training License associated with Physician & Surgeon License

License/Registration Role: Physician & Surgeon

Related Party Role: Postgraduate Training License

Name: KIM, JEONG HWAN JAKE

License/Registration Type: Postgraduate Training License

License Number: 7481 Primary Status: License Canceled

Address :
2124 Lyans Dr
LA CANADA FLINTRIDGE CA 91011-1539
LOS ANGELES COUNTY

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Survey Information

The following information is self-reported by the licensee and has not been verified by the Board.

Current Training Status
Fellow
Postgraduate Training Years
4
Primary Area of Practice
Cardiology
Secondary Area of Practice
Not Applicable
ABMS Certifications
American Board of Internal Medicine - Internal Medicine
Are you retired?
No
Practice Activities
Direct Patient Care (including telehealth) - 40+ Hours
Percentage (%) of patient care hours spent on telehealth - 0
Training - 40+ Hours
Research - 1-9 Hours
Administration - 1-9 Hours
Other - None
Primary Practice Location
Zip - 91360
United States Primary Practice Location
Secondary Practice Location
Zip - 91360
United States Secondary Practice Location
Are you Hispanic, Latino/a, or of Spanish origin?
No
Race
Asian - Korean
Language Fluency
English
Korean
Gender Identity
Male

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