Healthcare Provider Details

I. General information

NPI: 1700936374
Provider Name (Legal Business Name): BMB MEDICAL GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 03/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4160 WILSHIRE BLVD SUITE 303
LOS ANGELES CA
90010-3500
US

IV. Provider business mailing address

4160 WILSHIRE BLVD SUITE 303
LOS ANGELES CA
90010-3500
US

V. Phone/Fax

Practice location:
  • Phone: 323-965-9650
  • Fax: 323-965-9690
Mailing address:
  • Phone: 323-965-9650
  • Fax: 323-965-9690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberG64109
License Number StateCA

VIII. Authorized Official

Name: DR. WALTER J KIM
Title or Position: PRESIDENT
Credential: M.D.
Phone: 323-965-9650