Healthcare Provider Details

I. General information

NPI: 1770233314
Provider Name (Legal Business Name): ELIZABETH HYUN KIM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2022
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10833 LE CONTE AVE
LOS ANGELES CA
90095-3075
US

IV. Provider business mailing address

10833 LE CONTE AVE
LOS ANGELES CA
90095-3075
US

V. Phone/Fax

Practice location:
  • Phone: 310-825-5615
  • Fax:
Mailing address:
  • Phone: 310-825-5615
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA188962
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: