Provider Demographics
NPI:1003441262
Name:KIM, KENNETH TAEYOUNG
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:TAEYOUNG
Last Name:KIM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:924 WESTWOOD BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-2924
Mailing Address - Country:US
Mailing Address - Phone:310-794-0785
Mailing Address - Fax:
Practice Address - Street 1:924 WESTWOOD BLVD STE 300
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-2924
Practice Address - Country:US
Practice Address - Phone:310-794-0785
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-09
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program