Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0117X | Orthopaedic Spine Surgeon | A103614 | CA |
NPI | 1407990955 |
---|---|
Provider Name | Terrence T. Kim |
First Address | Los Angeles, CA 90048-4165 |
Second Address | Los Angeles, CA 90048-4165 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/02/2007 |
Last Update Date | 01/10/2014 |