Provider Demographics
NPI:1003811951
Name:WILLIAM C. KIM, M.D. INC
Entity Type:Organization
Organization Name:WILLIAM C. KIM, M.D. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCRACKEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-543-2521
Mailing Address - Street 1:4201 TORRANCE BLVD
Mailing Address - Street 2:STE 190
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-4539
Mailing Address - Country:US
Mailing Address - Phone:310-543-2521
Mailing Address - Fax:310-543-4754
Practice Address - Street 1:9930 TALBERT AVE
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-5153
Practice Address - Country:US
Practice Address - Phone:310-543-2521
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-16
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH62097Medicare UPIN
CAW11843CMedicare ID - Type UnspecifiedGROUP
CAA58674Medicare UPIN
CAA37226Medicare UPIN
CAF59697Medicare UPIN
CAA26741Medicare UPIN
CAF99475Medicare UPIN