Healthcare Provider Details

I. General information

NPI: 1659402071
Provider Name (Legal Business Name): JISUE KIM COYE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JISUE KIM MD

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 05/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20911 EARL ST SUITE 100
TORRANCE CA
90503-4352
US

IV. Provider business mailing address

20911 EARL ST SUITE 100
TORRANCE CA
90503-4352
US

V. Phone/Fax

Practice location:
  • Phone: 310-370-7759
  • Fax: 310-370-1590
Mailing address:
  • Phone: 310-370-7759
  • Fax: 310-370-1590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA77163
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: