Healthcare Provider Details

I. General information

NPI: 1639907447
Provider Name (Legal Business Name): ISAAC Y KIM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2024
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9333 IMPERIAL HWY
DOWNEY CA
90242-2812
US

IV. Provider business mailing address

13047 ANDY ST
CERRITOS CA
90703-6120
US

V. Phone/Fax

Practice location:
  • Phone: 562-657-9000
  • Fax:
Mailing address:
  • Phone: 562-896-8241
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number95002960
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: