Healthcare Provider Details

I. General information

NPI: 1215966395
Provider Name (Legal Business Name): SOUTH BAY FAMILY MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2006
Last Update Date: 04/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3701 SKYPARK DR SUITE 100
TORRANCE CA
90505-4753
US

IV. Provider business mailing address

3105 LOMITA BLVD
TORRANCE CA
90505-5108
US

V. Phone/Fax

Practice location:
  • Phone: 310-378-2234
  • Fax: 310-378-9795
Mailing address:
  • Phone: 310-784-4926
  • Fax: 310-891-6793

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateCA

VIII. Authorized Official

Name: WILLIAM KIM
Title or Position: PHYSICIAN
Credential: MD
Phone: 310-378-2234