Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | A50035 | CA |
NPI | 1134153653 |
---|---|
Provider Name | Seung H Kim |
First Address | Los Angeles, CA 90020-3049 |
Second Address | Los Angeles, CA 90020-3049 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A500350 | (05) | CA |
G16263 | (02) | CA |