MEDICARE: SENDIA KIM M.D.

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	208200000X	Plastic Surgery Physician	A99966	CA

General Provider Information

NPI Number	:	1043267321
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SENDIA KIM M.D.

Provider Business Mailing Address
First Line	:	6250 CANOGA AVE APT 401
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91367-2497
Country	:	US
Telephone Number	:	617-834-4688
Fax Number	:

Provider Business Practice Location Address
First Line	:	5601 DE SOTO AVE
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91367-6701
Country	:	US
Telephone Number	:	818-719-4505
Fax Number	:

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

Provider Enumeration Date	:	05/30/2006
Last Update Date	:	11/29/2021

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