MEDICARE: DR. NANCY M KIM MD

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	207R00000X	Internal Medicine Physician	MD428838	PA
2	207R00000X	Internal Medicine Physician	A82341	CA

General Provider Information

NPI Number	:	1063541761
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NANCY M KIM MD

Provider Business Mailing Address
First Line	:	1831 GLENDON AVE
Second Line	:	#3
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-4635
Country	:	US
Telephone Number	:	310-927-4719
Fax Number	:

Provider Business Practice Location Address
First Line	:	1831 GLENDON AVE
Second Line	:	#3
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-4635
Country	:	US
Telephone Number	:	310-927-4719
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/06/2007
Last Update Date	:	09/14/2009

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