MEDICARE: MYEONG CHEOL 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	208100000X	Physical Medicine & Rehabilitation Physician	C50796	CA

General Provider Information

NPI Number	:	1376655084
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MYEONG CHEOL KIM, M.D., INC.

Provider Business Mailing Address
First Line	:	2140 W OLYMPIC BLVD STE 210
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90006-2277
Country	:	US
Telephone Number	:	213-381-5454
Fax Number	:	213-381-5300

Provider Business Practice Location Address
First Line	:	2140 W OLYMPIC BLVD STE 210
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90006-2277
Country	:	US
Telephone Number	:	213-381-5454
Fax Number	:	213-381-5300

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MYEONG CHEOL KIM
Credential	:	M.D.
Telephone Number	:	213-381-5454

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	07/02/2020

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