Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | A173404 | CA |
NPI | 1003392309 |
---|---|
Provider Name | Haein Kim |
First Address | Inglewood, CA 90301-1708 |
Second Address | Inglewood, CA 90301-1708 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2018 |
Last Update Date | 25/01/2022 |