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General NPI Number Information
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NPI Number | 1497942932
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Entity Type | Organization
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Legal Business Name | SOUTHERN CALIFRONIA SPECIALISTS, INC
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Dates
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Enumeration Date | 09/28/2007
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Last Update Date | 09/28/2007
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Provider Practice Location Address
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Address Line | 11190 WARNER AVE SUITE 307
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City | FOUNTAIN VALLEY
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State | CA
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Zip | 92708-4019
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Country | US
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Telephone | 714-545-6400
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Fax |
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Provider Business Mailing Address
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Address Line | 11190 WARNER AVE SUITE 307
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City | FOUNTAIN VALLEY
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State | CA
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Zip | 92708-4019
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KENNETH KIM
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Credential | M.D.
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Telephone | 714-506-8094
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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