MEDICARE: KYUNG SAE 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	2084N0400X	Neurology Physician	A24811	CA

General Provider Information

NPI Number	:	1568517464
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYUNG SAE KIM M.D.

Provider Business Mailing Address
First Line	:	3663 W 6TH ST
Second Line	:	SUITE 201
City	:	LOS ANGELES
State	:	CA
Zip	:	90020-3049
Country	:	US
Telephone Number	:	213-389-0100
Fax Number	:	213-389-2099

Provider Business Practice Location Address
First Line	:	3663 W 6TH ST
Second Line	:	SUITE 201
City	:	LOS ANGELES
State	:	CA
Zip	:	90020-3049
Country	:	US
Telephone Number	:	213-389-0100
Fax Number	:	213-389-2099

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

Provider Enumeration Date	:	01/24/2007
Last Update Date	:	07/08/2007

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