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General NPI Number Information
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NPI Number | 1215966395
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Entity Type | Organization
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Legal Business Name | SOUTH BAY FAMILY MEDICAL GROUP
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Dates
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Enumeration Date | 07/01/2006
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Last Update Date | 04/05/2011
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Provider Practice Location Address
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Address Line | 3701 SKYPARK DR SUITE 100
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City | TORRANCE
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State | CA
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Zip | 90505-4753
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Country | US
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Telephone | 310-378-2234
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Fax | 310-378-9795
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Provider Business Mailing Address
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Address Line | 3105 LOMITA BLVD
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City | TORRANCE
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State | CA
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Zip | 90505-5108
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Country | US
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Telephone | 310-784-4926
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Fax | 310-891-6793
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Authorized Official
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Title or Position | PHYSICIAN
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Name | WILLIAM KIM
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Credential | MD
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Telephone | 310-378-2234
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State | CA
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