Healthcare Provider Details

I. General information

NPI: 1891502001
Provider Name (Legal Business Name): CHANGKYU KIM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2024
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9730 WILSHIRE BLVD STE 207
BEVERLY HILLS CA
90212-2004
US

IV. Provider business mailing address

3185 WILSHIRE BLVD UNIT 783
LOS ANGELES CA
90010-1253
US

V. Phone/Fax

Practice location:
  • Phone: 213-434-6756
  • Fax: 323-967-9000
Mailing address:
  • Phone: 213-434-6756
  • Fax: 323-967-9000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code342000000X
TaxonomyTransportation Network Company
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: