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NPI Code Detail

MEDICARE: SAM KIM PHYSICIAN SERVICES INC

MEDICARE: SAM KIM PHYSICIAN SERVICES INC
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
1261QP2300XPrimary Care Clinic/Center
2208000000XPediatrics Physician

General Provider Information

NPI Number : 1104465541
Entity Type Code : Organization
Provider Name (Legal Business Name) : SAM KIM PHYSICIAN SERVICES INC
Provider Business Mailing Address
First Line : 5400 BALBOA BLVD STE 326
Second Line :
City : ENCINO
State : CA
Zip : 91316-5214
Country : US
Telephone Number : 818-939-4511
Fax Number :
Provider Business Practice Location Address
First Line : 5400 BALBOA BLVD STE 326
Second Line :
City : ENCINO
State : CA
Zip : 91316-5214
Country : US
Telephone Number : 818-789-0941
Fax Number : 818-789-6726
Authorized Official
Title or Position : CEO
Name : SAMUEL SUNGWON KIM
Credential : M.D.
Telephone Number : 818-939-4511
Provider Enumeration Date : 01/02/2020
Last Update Date : 01/05/2026

Similar Medicare Providers

1023310687 — DR. SAMUEL SUNGWON KIM M.D.
Practice Location Address:
5400 BALBOA BLVD STE 326
ENCINO, CA
91316-5214
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Practice Fax: 818-789-6726
1134219983 — HELEN A LEDERER M.D.
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1619067477 — CATHERINE MARSHALL M.D.
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Practice Phone: 818-789-0941
Practice Fax: 818-789-6726
1528158300 — ANDREW D. KRASNOFF M.D.
Practice Location Address:
5400 BALBOA BLVD STE 326
ENCINO, CA
91316-5214
Practice Phone: 818-789-8987
Practice Fax: 818-789-6726
1447330626 — IRWIN BARRY BRUCKNER M.D.
Practice Location Address:
5400 BALBOA BLVD STE 326
ENCINO, CA
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Practice Phone: 818-789-0492
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1013097922 — LAURA BRUCKNER M.D.
Practice Location Address:
5400 BALBOA BLVD STE 326
ENCINO, CA
91316-5214
Practice Phone: 818-789-8775
Practice Fax: 818-789-6726

Directions to “SAM KIM PHYSICIAN SERVICES INC ” Practice Location

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