Healthcare Provider Details

I. General information

NPI: 1851986863
Provider Name (Legal Business Name): BEDFORD ANESTHESIA INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2021
Last Update Date: 03/02/2021
Certification Date: 03/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

436 N BEDFORD DR STE 305
BEVERLY HILLS CA
90210-4320
US

IV. Provider business mailing address

436 N BEDFORD DR STE 305
BEVERLY HILLS CA
90210-4320
US

V. Phone/Fax

Practice location:
  • Phone: 310-205-3646
  • Fax: 310-271-6996
Mailing address:
  • Phone: 310-205-3646
  • Fax: 310-271-6996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. EUGENE KYOUNGCHUL KIM
Title or Position: PRESIDENT
Credential: MD
Phone: 917-902-6811