Healthcare Provider Details

I. General information

NPI: 1508442377
Provider Name (Legal Business Name): PHILLIP KHAT KHIM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2021
Last Update Date: 04/11/2026
Certification Date: 04/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

757 WESTWOOD PLZ
LOS ANGELES CA
90095-8359
US

IV. Provider business mailing address

2332 S BENTLEY AVE APT 307
LOS ANGELES CA
90064-1949
US

V. Phone/Fax

Practice location:
  • Phone: 310-825-9111
  • Fax:
Mailing address:
  • Phone: 562-708-3494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number1508442377
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: