Healthcare Provider Details

I. General information

NPI: 1508927385
Provider Name (Legal Business Name): HYUNG S KIM MD A PROFESSIONAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8700 BEVERLY BLVD
WEST HOLLYWOOD CA
90048-1804
US

IV. Provider business mailing address

11856 BALBOA BLVD STE 419
GRANADA HILLS CA
91344-2753
US

V. Phone/Fax

Practice location:
  • Phone: 310-423-3618
  • Fax:
Mailing address:
  • Phone: 818-900-2908
  • Fax: 818-671-3815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberA81497
License Number StateCA

VIII. Authorized Official

Name: DR. HYUNG S KIM
Title or Position: OWNER
Credential: M.D.
Phone: 818-314-2337