MEDICARE: SHIN WOOK KANG MEDICAL CENTER 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
1	207R00000X	Internal Medicine Physician	W15560	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	:	1639357056
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHIN WOOK KANG MEDICAL CENTER INC

Provider Business Mailing Address
First Line	:	2727 W OLYMPIC BLVD STE 206
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90006-2640
Country	:	US
Telephone Number	:	213-380-7077
Fax Number	:

Provider Business Practice Location Address
First Line	:	2727 W OLYMPIC BLVD STE 206
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90006-2640
Country	:	US
Telephone Number	:	213-380-7077
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SHIN W KANG
Credential	:
Telephone Number	:	213-380-7077

Provider Enumeration Date	:	02/07/2008
Last Update Date	:	10/19/2010

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