Provider Demographics
NPI:1013001379
Name:KIM, KYU HYUN (MD)
Entity Type:Individual
Prefix:
First Name:KYU
Middle Name:HYUN
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:15243 VANOWEN ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405-3605
Mailing Address - Country:US
Mailing Address - Phone:818-786-4910
Mailing Address - Fax:818-786-5512
Practice Address - Street 1:15243 VANOWEN ST
Practice Address - Street 2:SUITE 300
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-3605
Practice Address - Country:US
Practice Address - Phone:818-786-4910
Practice Address - Fax:818-786-5512
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA51510208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics