Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0402X | Child Neurologist | A49011 | CA |
N | 2084N0600X | Clinical Neurophysiologist | A49011 | CA |
NPI | 1033268941 |
---|---|
Provider Name | James J Kim |
First Address | Los Angeles, CA 90020-1416 |
Second Address | Los Angeles, CA 90020-1416 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2007 |
Last Update Date | 07/08/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A490110 | (05) | CA |
E75047 | (02) |