Healthcare Provider Details

I. General information

NPI: 1437612066
Provider Name (Legal Business Name): PAUL KIM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2019
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 W CARSON ST
TORRANCE CA
90502-2059
US

IV. Provider business mailing address

12 EXECUTIVE PARK DR NE STE 331
ATLANTA GA
30329-2206
US

V. Phone/Fax

Practice location:
  • Phone: 424-306-4000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA205683
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: