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General NPI Number Information
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NPI Number | 1831575711
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Entity Type | Organization
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Legal Business Name | SANG DO KIM MD CORPORATION
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Dates
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Enumeration Date | 08/03/2015
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Last Update Date | 06/24/2016
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Provider Practice Location Address
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Address Line | 444 S SAN VICENTE BLVD STE 901
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City | LOS ANGELES
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State | CA
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Zip | 90048-4174
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Country | US
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Telephone | 310-248-7322
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Fax |
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Provider Business Mailing Address
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Address Line | 444 S SAN VICENTE BLVD STE 901
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City | LOS ANGELES
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State | CA
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Zip | 90048-4174
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Country | US
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Telephone | 310-248-7322
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | SANG KIM
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Credential | MD
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Telephone | 310-248-7322
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XS0117X
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Taxonomy Name | Orthopaedic Surgery of the Spine Physician
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License Number | A125380
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License Number State | CA
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