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NPI Code Detail

MEDICARE: DR. SUNDRA S KIM MD

MEDICARE:  DR. SUNDRA S 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
1207RG0300XGeriatric Medicine (Internal Medicine) PhysicianH5412TX
2207RG0300XGeriatric Medicine (Internal Medicine) PhysicianG43226CA
3207R00000XInternal Medicine PhysicianG43226CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1H5412OTHERTXTEXAS STATE MEDICAL LICENSE
2G43226OTHERCACALIFORNIA STATE MEDICAL LICENSE

General Provider Information

NPI Number : 1518920735
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SUNDRA S KIM MD
Provider Business Mailing Address
First Line : 1776 E CENTURY BLVD
Second Line :
City : LOS ANGELES
State : CA
Zip : 90002-3050
Country : US
Telephone Number : 323-374-6848
Fax Number : 323-374-6691
Provider Business Practice Location Address
First Line : 1776 E CENTURY BLVD
Second Line :
City : LOS ANGELES
State : CA
Zip : 90002-3050
Country : US
Telephone Number : 323-374-6848
Fax Number : 323-374-6691
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/10/2006
Last Update Date : 07/10/2024

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Directions to “ DR. SUNDRA S KIM MD” Practice Location

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