Healthcare Provider Details

I. General information

NPI: 1275573669
Provider Name (Legal Business Name): KIM VANNETTE FOUCHE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 06/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5925 SAN VICENTE BLVD
LOS ANGELES CA
90019-6630
US

IV. Provider business mailing address

PO BOX 661748
ARCADIA CA
91066-1748
US

V. Phone/Fax

Practice location:
  • Phone: 323-932-5105
  • Fax: 323-932-5356
Mailing address:
  • Phone: 626-447-0296
  • Fax: 626-447-6057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberG62088
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: