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General NPI Number Information
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NPI Number | 1639405293
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Entity Type | Organization
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Legal Business Name | UNIVERSAL SPECIALTIES MEDICAL GROUP, P.C.
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Dates
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Enumeration Date | 11/02/2009
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Last Update Date | 11/02/2009
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Provider Practice Location Address
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Address Line | 440 SHATTO PL 2ND FLOOR #208
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City | LOS ANGELES
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State | CA
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Zip | 90020-1765
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Country | US
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Telephone | 213-536-4242
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Fax | 866-438-5974
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Provider Business Mailing Address
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Address Line | 440 SHATTO PL 2ND FLOOR #208
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City | LOS ANGELES
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State | CA
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Zip | 90020-1765
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Country | US
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Telephone | 213-536-4242
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Fax | 866-438-5974
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Authorized Official
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Title or Position | PRESIDENT
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Name | TAE SOON KIM
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Credential | M.D.
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Telephone | 213-536-4242
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | A32370
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License Number State | CA
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