Healthcare Provider Details

I. General information

NPI: 1477516276
Provider Name (Legal Business Name): C CHRISTOPHER KIM M D A PROF CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 02/24/2020
Certification Date: 02/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24355 LYONS AVE STE.# 120
SANTA CLARITA CA
91321-2300
US

IV. Provider business mailing address

PO BOX 7001
TARZANA CA
91357-7001
US

V. Phone/Fax

Practice location:
  • Phone: 661-255-6644
  • Fax: 818-715-1722
Mailing address:
  • Phone: 818-888-7815
  • Fax: 818-715-1722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA39954
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberA39954
License Number StateCA

VIII. Authorized Official

Name: CHRISTOPHER KIM
Title or Position: SOLE OWNER
Credential: M.D.
Phone: 818-888-7815