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NPI Code Detail

MEDICARE: KIM ENOMOTO M.D., M.P.H.

MEDICARE: KIM ENOMOTO M.D., M.P.H.
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
1207Q00000XFamily Medicine PhysicianG45177CA

General Provider Information

NPI Number : 1861534455
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIM ENOMOTO M.D., M.P.H.
Provider Business Mailing Address
First Line : 5205 MELROSE AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90038-3144
Country : US
Telephone Number : 323-653-8622
Fax Number :
Provider Business Practice Location Address
First Line : 5205 MELROSE AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90038-3144
Country : US
Telephone Number : 323-653-8622
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/12/2007
Last Update Date : 01/09/2010

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