MEDICARE: DR. JOSEPH 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	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	G52950	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	:	1790892115
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH KIM M.D.

Provider Business Mailing Address
First Line	:	3000 W OLYMPIC BLVD
Second Line	:	SUITE 202
City	:	LOS ANGELES
State	:	CA
Zip	:	90006-2516
Country	:	US
Telephone Number	:	213-380-1388
Fax Number	:

Provider Business Practice Location Address
First Line	:	3000 W OLYMPIC BLVD
Second Line	:	SUITE 202
City	:	LOS ANGELES
State	:	CA
Zip	:	90006-2516
Country	:	US
Telephone Number	:	213-380-1388
Fax Number	:

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

Provider Enumeration Date	:	08/23/2006
Last Update Date	:	03/19/2020

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