Healthcare Provider Details

I. General information

NPI: 1184723231
Provider Name (Legal Business Name): BERNARD SUNGWON KIM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 03/10/2020
Certification Date: 03/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1245 WILSHIRE BLVD STE 503
LOS ANGELES CA
90017-4805
US

IV. Provider business mailing address

1245 WILSHIRE BLVD STE 503
LOS ANGELES CA
90017-4805
US

V. Phone/Fax

Practice location:
  • Phone: 213-977-4979
  • Fax: 213-977-0544
Mailing address:
  • Phone: 213-977-4979
  • Fax: 213-977-0544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA108352
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberA108352
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberA108352
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: