Provider Demographics
NPI:1003837840
Name:KIM, STANLEY S (MD)
Entity Type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:S
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3663 W 6TH ST
Mailing Address - Street 2:SUITE #200
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90020-3049
Mailing Address - Country:US
Mailing Address - Phone:213-385-8500
Mailing Address - Fax:213-385-4896
Practice Address - Street 1:3663 W 6TH ST
Practice Address - Street 2:SUITE #200
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90020-3049
Practice Address - Country:US
Practice Address - Phone:213-385-8500
Practice Address - Fax:213-385-4896
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2014-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG54395207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G543950Medicaid
CAG54395Medicare ID - Type Unspecified
CA00G543950Medicaid
CA00G543950Medicaid