Healthcare Provider Details

I. General information

NPI: 1366448763
Provider Name (Legal Business Name): WILLIAM C. KIM, M.D., INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 03/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 E. 28TH STREET SUITE 117
LONG BEACH CA
90806-2772
US

IV. Provider business mailing address

4201 TORRANCE BLVD. SUITE 190
TORRANCE CA
90503-4539
US

V. Phone/Fax

Practice location:
  • Phone: 562-426-9890
  • Fax: 562-426-7809
Mailing address:
  • Phone: 310-543-2521
  • Fax: 310-543-4754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MS. MELANIE MCCRACKEN
Title or Position: ADMINISTRATOR
Credential: CPC
Phone: 310-543-2521