MEDICARE: DR. DORAN A 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	207R00000X	Internal Medicine Physician	G81839	CA

General Provider Information

NPI Number	:	1780775312
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DORAN A KIM M.D.

Provider Business Mailing Address
First Line	:	625 S BERENDO ST
Second Line	:	PH-2
City	:	LOS ANGELES
State	:	CA
Zip	:	90005-1718
Country	:	US
Telephone Number	:	310-409-9075
Fax Number	:	213-365-1626

Provider Business Practice Location Address
First Line	:	3435 WILSHIRE BLVD
Second Line	:	#2700
City	:	LOS ANGELES
State	:	CA
Zip	:	90010-1901
Country	:	US
Telephone Number	:	310-409-9075
Fax Number	:	213-365-1626

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/27/2006
Last Update Date	:	07/12/2007

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