MEDICARE: SARA H KIM MD A MEDICAL CORPORATION

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	2085R0001X	Radiation Oncology Physician	A71344	CA

General Provider Information

NPI Number	:	1568601797
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SARA H KIM MD A MEDICAL CORPORATION

Provider Business Mailing Address
First Line	:	PO BOX 65
Second Line	:
City	:	SIMI VALLEY
State	:	CA
Zip	:	93062-0065
Country	:	US
Telephone Number	:	310-500-9997
Fax Number	:

Provider Business Practice Location Address
First Line	:	381 MERRILL AVE
Second Line	:	SUITE A
City	:	GLENDALE
State	:	CA
Zip	:	91206-4119
Country	:	US
Telephone Number	:	818-409-8198
Fax Number	:	818-956-7602

Authorized Official
Title or Position	:	CEO
Name	:	DR. SARA H KIM
Credential	:	MD
Telephone Number	:	310-500-9997

Provider Enumeration Date	:	02/11/2009
Last Update Date	:	03/13/2012

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