Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 29582 | AL |
N | 207VX0201X | Gynecologic Oncologist | 2012-01379 | NC |
Y | 207VX0201X | Gynecologic Oncologist | C169111 | CA |
NPI | 1235347477 |
---|---|
Provider Name | Kenneth Hyunchung Kim |
First Address | Torrance, CA 90504-5513 |
Second Address | West Hollywood, CA 90048-1804 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2007 |
Last Update Date | 02/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
051599094 | BCBS (01) | AL |
051599095 | BCBS (01) | AL |
051599096 | BCBS (01) | AL |
051599097 | BCBS (01) | AL |
051599098 | BCBS (01) | AL |
051599099 | BCBS (01) | AL |
09334346 | (05) | MS |
111021 | (05) | AL |
119155 | (05) | AL |
119158 | (05) | AL |
119288 | (05) | AL |
119289 | (05) | AL |
119290 | (05) | AL |
P00908739 | RAILROAD MEDICARE (01) | AL |
Z01955 | VIVA (01) | AL |