Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | A128878 | CA |
N | 2086S0120X | Pediatric Surgery | M1831 | TX |
NPI | 1538121140 |
---|---|
Provider Name | Eugene Sungkyun Kim |
First Address | Los Angeles, CA 90028-7901 |
Second Address | Los Angeles, CA 90027-6062 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2006 |
Last Update Date | 09/05/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
112545205 | (05) | TX |
188589901 | (05) | TX |
188589904 | (05) | TX |