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General NPI Number Information
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NPI Number | 1912331653
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Entity Type | Organization
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Legal Business Name | BEVERLY CARDIOLOGY GROUP
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Dates
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Enumeration Date | 08/29/2013
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Last Update Date | 08/29/2013
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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 | 323-662-7817
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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 | 323-662-7817
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. DIANA KIM
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Credential | M.D.
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Telephone | 323-662-1175
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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