MEDICARE: JI YEON KIM MD, MPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207ZP0105X	Clinical Pathology/Laboratory Medicine Physician	A122377	CA

General Provider Information

NPI Number	:	1003011677
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JI YEON KIM MD, MPH

Provider Business Mailing Address
First Line	:	11668 SHERMAN WAY
Second Line	:	ADMIN
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91605-5831
Country	:	US
Telephone Number	:	818-503-6710
Fax Number	:

Provider Business Practice Location Address
First Line	:	11668 SHERMAN WAY
Second Line	:	ADMIN
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91605-5831
Country	:	US
Telephone Number	:	818-503-6710
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2007
Last Update Date	:	11/29/2021

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