MEDICARE: IL YOUNG KIM MD FACC A MEDICAL CORP

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	261Q00000X	Clinic/Center	A33707	CA

Other Identifiers

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

General Provider Information

NPI Number	:	1316130099
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IL YOUNG KIM MD FACC A MEDICAL CORP

Provider Business Mailing Address
First Line	:	3919 BEVERLY BLVD
Second Line	:	#100
City	:	LOS ANGELES
State	:	CA
Zip	:	90004-3432
Country	:	US
Telephone Number	:	323-662-1175
Fax Number	:	323-662-7817

Provider Business Practice Location Address
First Line	:	3919 BEVERLY BLVD
Second Line	:	#100
City	:	LOS ANGELES
State	:	CA
Zip	:	90004-3432
Country	:	US
Telephone Number	:	323-662-1175
Fax Number	:	323-662-7817

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. IL YOUNG KIM
Credential	:	M.D.
Telephone Number	:	323-662-1175

Provider Enumeration Date	:	08/24/2007
Last Update Date	:	07/20/2010

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