Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | A51510 | CA |
NPI | 1013001379 |
---|---|
Provider Name | Kyu Hyun Kim |
First Address | Van Nuys, CA 91405-3605 |
Second Address | Van Nuys, CA 91405-3605 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 23/02/2016 |