MEDICARE: CHUNG W. 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
1	208000000X	Pediatrics Physician	A034623	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	:	1669694279
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHUNG W. KIM,M.D.

Provider Business Mailing Address
First Line	:	4082 WHITTIER BLVD
Second Line	:	STE 102
City	:	LOS ANGELES
State	:	CA
Zip	:	90023-2558
Country	:	US
Telephone Number	:	323-261-2111
Fax Number	:

Provider Business Practice Location Address
First Line	:	4082 WHITTIER BLVD
Second Line	:	STE 102
City	:	LOS ANGELES
State	:	CA
Zip	:	90023-2558
Country	:	US
Telephone Number	:	323-261-2111
Fax Number	:

Authorized Official
Title or Position	:	M.D.
Name	:	CHUNG W KIM
Credential	:	M.D.
Telephone Number	:	323-261-2111

Provider Enumeration Date	:	05/03/2007
Last Update Date	:	08/22/2020

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