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General NPI Number Information
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NPI Number | 1831049618
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Entity Type | Organization
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Legal Business Name | PACIFIC SENIOR MEDICAL GROUP
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Dates
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Enumeration Date | 01/30/2026
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Last Update Date | 01/30/2026
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Provider Practice Location Address
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Address Line | 520 S VIRGIL AVE STE 106
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City | LOS ANGELES
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State | CA
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Zip | 90020-1417
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Country | US
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Telephone | 213-234-5575
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Fax |
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Provider Business Mailing Address
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Address Line | 520 S VIRGIL AVE STE 106
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City | LOS ANGELES
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State | CA
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Zip | 90020-1417
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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 | KENNETH K KIM
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Credential | MD
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Telephone | 213-234-5575
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number |
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License Number State |
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