Healthcare Provider Details

I. General information

NPI: 1023310687
Provider Name (Legal Business Name): SAMUEL SUNGWON KIM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: SAMMY KIM M.D.

II. Dates (important events)

Enumeration Date: 12/02/2010
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5400 BALBOA BLVD STE 326
ENCINO CA
91316-5214
US

IV. Provider business mailing address

5400 BALBOA BLVD STE 326
ENCINO CA
91316-5214
US

V. Phone/Fax

Practice location:
  • Phone: 818-789-0941
  • Fax: 818-789-6726
Mailing address:
  • Phone: 818-789-0941
  • Fax: 818-789-6726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA114873
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: