Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | G061259 | CA |
NPI | 1205833563 |
---|---|
Provider Name | Kenneth T Kim |
First Address | Long Beach, CA 90806-2330 |
Second Address | Long Beach, CA 90806-2330 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E36029 | (02) |