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General NPI Number Information
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NPI Number | 1447495627
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Entity Type | Organization
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Legal Business Name | KENNETH K. KIM, M.D., A PROFESSIONAL MEDICAL CORPORATION
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Dates
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Enumeration Date | 12/02/2008
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Last Update Date | 05/06/2015
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Provider Practice Location Address
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Address Line | 5757 WILSHIRE BLVD SUITE 348
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City | LOS ANGELES
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State | CA
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Zip | 90036-5810
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Country | US
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Telephone | 213-700-4297
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Fax | 323-424-4080
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Provider Business Mailing Address
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Address Line | 5757 WILSHIRE BLVD SUITE 348
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City | LOS ANGELES
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State | CA
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Zip | 90036-5810
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Country | US
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Telephone | 213-700-4297
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Fax | 323-424-4080
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Authorized Official
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Title or Position | CEO
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Name | KENNETH K. KIM
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Credential | M.D.
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Telephone | 310-882-8482
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | A81964
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License Number State | CA
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