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General NPI Number Information
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NPI Number | 1578060976
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Entity Type | Individual
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Provider Name | STAECY Y KIM MD
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Gender | Female
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Dates
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Enumeration Date | 04/11/2018
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Last Update Date | 12/19/2024
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Provider Practice Location Address
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Address Line | 18321 CLARK ST
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City | TARZANA
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State | CA
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Zip | 91356-3501
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Country | US
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Telephone | 818-708-5570
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Fax | 818-708-5471
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Provider Business Mailing Address
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Address Line | 4140 W 190TH ST
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City | TORRANCE
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State | CA
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Zip | 90504-5513
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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 |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080N0001X
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Taxonomy Name | Neonatal-Perinatal Medicine Physician
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License Number | A173674
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License Number State | CA
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