MEDICARE: DENNY HAN-WOONG KIM DO

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	20A9277	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1740332055
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENNY HAN-WOONG KIM DO

Provider Business Mailing Address
First Line	:	393 E WALNUT ST
Second Line	:	3RD FLOOR PHR SYSTEMS
City	:	PASADENA
State	:	CA
Zip	:	91188-0001
Country	:	US
Telephone Number	:	323-783-5240
Fax Number	:	323-783-5240

Provider Business Practice Location Address
First Line	:	1526 N EDGEMONT ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90027-5260
Country	:	US
Telephone Number	:	323-783-5240
Fax Number	:

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

Provider Enumeration Date	:	01/17/2007
Last Update Date	:	10/15/2015

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