Healthcare Provider Details

I. General information

NPI: 1952875098
Provider Name (Legal Business Name): GRACE KIM AUSTIN MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2019
Last Update Date: 01/22/2021
Certification Date: 01/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3527 OCEAN VIEW BLVD
GLENDALE CA
91208-1211
US

IV. Provider business mailing address

3527 OCEAN VIEW BLVD
GLENDALE CA
91208-1211
US

V. Phone/Fax

Practice location:
  • Phone: 747-203-7750
  • Fax: 818-659-7694
Mailing address:
  • Phone: 747-203-7750
  • Fax: 818-659-7694

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: GRACE K AUSTIN
Title or Position: PRESIDENT
Credential: MD
Phone: 747-203-7750