Healthcare Provider Details

I. General information

NPI: 1194598383
Provider Name (Legal Business Name): PROTESTANT JOHN CALVIN MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2023
Last Update Date: 10/31/2023
Certification Date: 10/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4305 TORRANCE BLVD STE 208
TORRANCE CA
90503-4418
US

IV. Provider business mailing address

4220 W 3RD ST STE 201
LOS ANGELES CA
90020-3450
US

V. Phone/Fax

Practice location:
  • Phone: 310-710-7002
  • Fax: 213-487-0124
Mailing address:
  • Phone: 213-352-1223
  • Fax: 213-487-0124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CALVIN A. KIM
Title or Position: CEO/PHYSICIAN DIRECTOR
Credential: MD
Phone: 213-352-1223