=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003832858
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SANG Y. KIM, M.D., INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/14/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3020 WILSHIRE BLVD STE 160
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90010-1120
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 213-738-0045
-----------------------------------------------------
Fax | 213-738-0032
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3020 WILSHIRE BLVD STE 160
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90010-1120
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 213-738-0045
-----------------------------------------------------
Fax | 213-738-0032
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | SANG Y KIM
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 213-738-0045
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number | A41877
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------