MEDICARE: PACIFIC SENIOR MEDICAL GROUP

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	302R00000X	Health Maintenance Organization

General Provider Information

NPI Number	:	1831049618
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PACIFIC SENIOR MEDICAL GROUP

Provider Business Mailing Address
First Line	:	520 S VIRGIL AVE STE 106
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90020-1417
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	520 S VIRGIL AVE STE 106
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90020-1417
Country	:	US
Telephone Number	:	213-234-5575
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	KENNETH K KIM
Credential	:	MD
Telephone Number	:	213-234-5575

Provider Enumeration Date	:	01/30/2026
Last Update Date	:	01/30/2026

Similar Medicare Providers

1225238769 — EZ DIAGNOSIS CENTER LLC
Practice Location Address:

520 S VIRGIL AVE STE 104
LOS ANGELES, CA
90020-1417

Practice Phone: 213-387-2212
Practice Fax:

1295004034 — KENNETH K KIM, A MEDICAL CORPORATION
Practice Location Address:

520 S VIRGIL AVE , SUITE 106
LOS ANGELES, CA
90020-1417

Practice Phone: 213-234-5575
Practice Fax: 213-427-9850

1396678140 — GILLIAN ERIN NUNEZ CARLOS MS, CGC
Practice Location Address:

3101 SAWTELLE BLVD APT 309
LOS ANGELES, CA
90066-1417

Practice Phone: 925-640-0226
Practice Fax: 364-407-9394

1417597527 — DR. AARON LEONARD MISHARA
Practice Location Address:

1417 VETERAN AVE APT 108
LOS ANGELES, CA
90024-4856

Practice Phone: 773-750-7060
Practice Fax:

1477531689 — MARJORIE B FINE MD
Practice Location Address:

1417 N KENTER AVE
LOS ANGELES, CA
90049-1321

Practice Phone: 310-472-7481
Practice Fax:

1689775892 — SEMYON I EMERT M.D.
Practice Location Address:

1417 1/2N GARDNER ST
LOS ANGELES, CA
90046-4156

Practice Phone: 323-646-2506
Practice Fax: 323-850-0784

Directions to “PACIFIC SENIOR MEDICAL GROUP ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.