Healthcare Provider Details

I. General information

NPI: 1528055456
Provider Name (Legal Business Name): YANG KIM M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 08/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 S VIRGIL AVE # 2047A
LOS ANGELES CA
90020
US

IV. Provider business mailing address

500 S VIRGIL AVE STE 204
LOS ANGELES CA
90020-1449
US

V. Phone/Fax

Practice location:
  • Phone: 213-388-7828
  • Fax: 213-388-7838
Mailing address:
  • Phone: 213-388-7828
  • Fax: 213-388-7838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number190095
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: