Healthcare Provider Details

I. General information

NPI: 1164501888
Provider Name (Legal Business Name): KYUNG OK KIM HUH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 08/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 W BEVERLY BLVD
MONTEBELLO CA
90640-4308
US

IV. Provider business mailing address

225 S LAKE AVE #535
PASADENA CA
91101-3005
US

V. Phone/Fax

Practice location:
  • Phone: 323-725-4209
  • Fax: 323-725-5005
Mailing address:
  • Phone: 626-795-6596
  • Fax: 626-795-8247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA25191
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: