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NPI Code Detail

MEDICARE: STEPHEN LYO-SUNG KIM M.D.

MEDICARE: STEPHEN LYO-SUNG 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
1207L00000XAnesthesiology PhysicianG76433CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
100G764333OTHERCABLUE SHIELD
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1497761027
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHEN LYO-SUNG KIM M.D.
Provider Business Mailing Address
First Line : 225 S LAKE AVE
Second Line : 535
City : PASADENA
State : CA
Zip : 91101-3005
Country : US
Telephone Number : 626-795-6596
Fax Number : 626-795-8247
Provider Business Practice Location Address
First Line : 1246 W 155TH ST
Second Line :
City : GARDENA
State : CA
Zip : 90247-4011
Country : US
Telephone Number : 310-323-5330
Fax Number : 310-768-2223
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/01/2006
Last Update Date : 02/25/2014

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