Healthcare Provider Details

I. General information

NPI: 1720251184
Provider Name (Legal Business Name): SEAN RIM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2008
Last Update Date: 09/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 N ROXBURY DR STE 100
BEVERLY HILLS CA
90210-5027
US

IV. Provider business mailing address

4440 SEPULVEDA BLVD APT 217
SHERMAN OAKS CA
91403-3903
US

V. Phone/Fax

Practice location:
  • Phone: 917-468-6893
  • Fax:
Mailing address:
  • Phone: 917-468-6893
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number257737
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA123588
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: