Healthcare Provider Details

I. General information

NPI: 1952790248
Provider Name (Legal Business Name): AMY L KIM A CALIFORNIA MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2015
Last Update Date: 01/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 S RAYMOND AVE
PASADENA CA
91105-3229
US

IV. Provider business mailing address

PO BOX 90730
PASADENA CA
91109-0730
US

V. Phone/Fax

Practice location:
  • Phone: 626-795-8051
  • Fax: 626-795-7374
Mailing address:
  • Phone: 626-795-8051
  • Fax: 626-795-7374

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA102809
License Number StateCA

VIII. Authorized Official

Name: MRS. AMY L KIM
Title or Position: MANAGER
Credential: MD
Phone: 626-795-8051