Healthcare Provider Details

I. General information

NPI: 1033268941
Provider Name (Legal Business Name): JAMES J KIM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 08/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 S VIRGIL AVE SUITE 307
LOS ANGELES CA
90020-1416
US

IV. Provider business mailing address

520 S VIRGIL AVE SUITE 307
LOS ANGELES CA
90020-1416
US

V. Phone/Fax

Practice location:
  • Phone: 213-386-2500
  • Fax: 213-386-6787
Mailing address:
  • Phone: 213-386-2500
  • Fax: 213-386-6787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License NumberA49011
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License NumberA49011
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2084P0005X
TaxonomyNeurodevelopmental Disabilities Physician
License NumberA49011
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License NumberA49011
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: