Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204F00000X | Transplant Surgeon | 263904 | NY |
Y | 204F00000X | Transplant Surgeon | A86557 | CA |
N | 208200000X | Surgeon | 53104-020 | WI |
N | 208600000X | Surgeon | 53104-020 | WI |
NPI | 1174602817 |
---|---|
Provider Name | Jim Kim |
First Address | Los Angeles, CA 90031-0309 |
Second Address | Los Angeles, CA 90033-5313 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2006 |
Last Update Date | 13/09/2020 |