Healthcare Provider Details

I. General information

NPI: 1114007754
Provider Name (Legal Business Name): KYU HYUN KIM MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 03/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15243 VANOWEN ST SUITE 300
VAN NUYS CA
91405-3605
US

IV. Provider business mailing address

15243 VANOWEN ST SUITE 300
VAN NUYS CA
91405-3605
US

V. Phone/Fax

Practice location:
  • Phone: 818-786-4910
  • Fax: 818-786-5512
Mailing address:
  • Phone: 818-786-4910
  • Fax: 818-786-5512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: KYU HYUN KIM
Title or Position: PRESIDENT
Credential: M D
Phone: 818-786-4910