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General NPI Number Information
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NPI Number | 1134650500
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Entity Type | Organization
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Legal Business Name | SOUTHERN CALIFORNIA FOOT AND ANKLE MEDICAL CENTER
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Dates
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Enumeration Date | 03/27/2017
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Last Update Date | 12/20/2022
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Provider Practice Location Address
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Address Line | 520 S VIRGIL AVE SUITE 105
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City | LOS ANGELES
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State | CA
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Zip | 90020-1416
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Country | US
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Telephone | 213-352-1090
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Fax | 562-249-8443
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Provider Business Mailing Address
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Address Line | 520 S VIRGIL AVE SUITE 105
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City | LOS ANGELES
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State | CA
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Zip | 90020-1416
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Country | US
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Telephone | 213-352-1090
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Fax | 562-249-8443
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Authorized Official
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Title or Position | SECRETARY
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Name | DR. SANG YUP KIM
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Credential | D.P.M
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Telephone | 562-606-4519
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | E5105
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License Number State | CA
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