MEDICARE: DR. KEVIN C KIM M.D

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	207Q00000X	Family Medicine Physician	A47843	CA

General Provider Information

NPI Number	:	1104994557
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEVIN C KIM M.D

Provider Business Mailing Address
First Line	:	3663 W. 6TH ST #302
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90020
Country	:	US
Telephone Number	:	213-738-1644
Fax Number	:

Provider Business Practice Location Address
First Line	:	3663 W 6TH ST # SUIT302
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90020-3049
Country	:	US
Telephone Number	:	213-738-1644
Fax Number	:

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

Provider Enumeration Date	:	12/02/2006
Last Update Date	:	07/08/2007

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