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General NPI Number Information
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NPI Number | 1780811844
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Entity Type | Individual
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Provider Name | DIANA MARIA KIM M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/16/2009
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Last Update Date | 08/28/2013
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Provider Practice Location Address
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Address Line | 3919 BEVERLY BLVD #100
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City | LOS ANGELES
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State | CA
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Zip | 90004-3432
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Country | US
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Telephone | 323-662-1175
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Fax |
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Provider Business Mailing Address
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Address Line | 3919 BEVERLY BLVD #100
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City | LOS ANGELES
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State | CA
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Zip | 90004-3432
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Country | US
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Telephone | 323-662-1175
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 252607-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | A112970
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License Number State | CA
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