Healthcare Provider Details

I. General information

NPI: 1659011310
Provider Name (Legal Business Name): RACHEL KIM-CHIE TO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2022
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1245 16TH ST STE 125
SANTA MONICA CA
90404-1240
US

IV. Provider business mailing address

757 WESTWOOD PLZ STE 7501
LOS ANGELES CA
90095-8358
US

V. Phone/Fax

Practice location:
  • Phone: 310-315-8900
  • Fax:
Mailing address:
  • Phone: 858-216-5973
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA209319
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: