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General NPI Number Information
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NPI Number | 1306199450
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Entity Type | Organization
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Legal Business Name | SANG IL KIM M.D. A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 10/25/2012
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 12610 VENTURA BLVD
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City | STUDIO CITY
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State | CA
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Zip | 91604-2414
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Country | US
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Telephone | 818-505-0053
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Fax | 818-505-0343
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Provider Business Mailing Address
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Address Line | 12610 VENTURA BLVD
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City | STUDIO CITY
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State | CA
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Zip | 91604-2414
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Country | US
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Telephone | 818-505-0053
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Fax | 818-505-0343
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Authorized Official
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Title or Position | OWNER
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Name | SANG IL KIM
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Credential | M.D.
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Telephone | 818-505-0053
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | C42314
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License Number State | CA
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