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General NPI Number Information
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NPI Number | 1962809400
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Entity Type | Organization
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Legal Business Name | SKIN AESTHETIC MEDICAL, INC
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Dates
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Enumeration Date | 11/26/2014
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Last Update Date | 12/17/2014
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Provider Practice Location Address
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Address Line | 3700 WILSHIRE BLVD SUITE 310
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City | LOS ANGELES
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State | CA
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Zip | 90010-2901
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Country | US
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Telephone | 310-858-9600
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Fax |
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Provider Business Mailing Address
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Address Line | 3700 WILSHIRE BLVD SUITE 310
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City | LOS ANGELES
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State | CA
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Zip | 90010-2901
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Country | US
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Telephone | 310-858-9600
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MICHAEL KIM
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Credential | M.D.
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Telephone | 310-858-9600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | G89056
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License Number State | CA
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