Healthcare Provider Details

I. General information

NPI: 1922983089
Provider Name (Legal Business Name): MOONSUK KIM PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2025
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3727 W 6TH ST STE 200
LOS ANGELES CA
90020-5108
US

IV. Provider business mailing address

3727 W 6TH ST STE 200
LOS ANGELES CA
90020-5108
US

V. Phone/Fax

Practice location:
  • Phone: 213-235-2500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA68554
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: