Healthcare Provider Details

I. General information

NPI: 1104313543
Provider Name (Legal Business Name): NORA CHUNG KIM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2018
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 STEIN PLAZA STE 562
LOS ANGELES CA
90095-0001
US

IV. Provider business mailing address

300 STEIN PLAZA STE 562
LOS ANGELES CA
90095-0001
US

V. Phone/Fax

Practice location:
  • Phone: 310-825-5111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberA208270
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: