MEDICARE: WILLIAM C. KIM, M.D. INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

General Provider Information

NPI Number	:	1003811951
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILLIAM C. KIM, M.D. INC

Provider Business Mailing Address
First Line	:	4201 TORRANCE BLVD
Second Line	:	STE 190
City	:	TORRANCE
State	:	CA
Zip	:	90503-4539
Country	:	US
Telephone Number	:	310-543-2521
Fax Number	:	310-543-4754

Provider Business Practice Location Address
First Line	:	9930 TALBERT AVE
Second Line	:
City	:	FOUNTAIN VALLEY
State	:	CA
Zip	:	92708-5153
Country	:	US
Telephone Number	:	310-543-2521
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MS. MELANIE MCCRACKEN
Credential	:
Telephone Number	:	310-543-2521

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	02/17/2009

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