MEDICARE: LA TOWN MEDICAL GROUP, 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	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	A50035	CA

General Provider Information

NPI Number	:	1831129063
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LA TOWN MEDICAL GROUP, INC.

Provider Business Mailing Address
First Line	:	3663 W 6TH ST
Second Line	:	SUITE 206
City	:	LOS ANGELES
State	:	CA
Zip	:	90020-3049
Country	:	US
Telephone Number	:	213-385-5500
Fax Number	:	213-385-1455

Provider Business Practice Location Address
First Line	:	3663 W 6TH ST
Second Line	:	SUITE 206
City	:	LOS ANGELES
State	:	CA
Zip	:	90020-3049
Country	:	US
Telephone Number	:	213-385-5500
Fax Number	:	213-385-1455

Authorized Official
Title or Position	:	CEO
Name	:	SEUNG H KIM
Credential	:	M.D.
Telephone Number	:	213-385-5500

Provider Enumeration Date	:	07/04/2006
Last Update Date	:	08/22/2020

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Directions to “LA TOWN MEDICAL GROUP, INC. ” Practice Location

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