Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | G54395 | CA |
NPI | 1003837840 |
---|---|
Provider Name | Dr. Stanley S. Kim |
First Address | Los Angeles, CA 90020-3049 |
Second Address | Los Angeles, CA 90020-3049 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2006 |
Last Update Date | 01/05/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G543950 | (05) | CA |
C36130 | (02) | CA |