=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881070746
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEI-PAIK KIM M D INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/03/2015
-----------------------------------------------------
Last Update Date | 08/03/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3663 W 6TH ST 203
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90020-3049
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 213-480-1251
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3663 W 6TH ST 203
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90020-3049
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 213-480-1251
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. HEI PAIK KIM
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 213-480-1251
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number | A33208
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------