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NPI Code Detail

MEDICARE: ISAAC KWANGNYON KIM MD

MEDICARE: ISAAC KWANGNYON KIM MD
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
1207Q00000XFamily Medicine PhysicianA87972CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1134223134
Entity Type Code : Individual
Provider Name (Legal Business Name) : ISAAC KWANGNYON KIM MD
Provider Business Mailing Address
First Line : 1125 E BROADWAY
Second Line : BOX 71
City : GLENDALE
State : CA
Zip : 91205-1315
Country : US
Telephone Number : 818-500-5586
Fax Number : 818-500-5583
Provider Business Practice Location Address
First Line : 4476 TWEEDY BLVD
Second Line :
City : SOUTH GATE
State : CA
Zip : 90280-6359
Country : US
Telephone Number : 323-825-8300
Fax Number : 866-372-2719
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/11/2006
Last Update Date : 08/23/2021

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