Provider Demographics
NPI:1023183258
Name:KIM, LEONARD H (MD)
Entity Type:Individual
Prefix:
First Name:LEONARD
Middle Name:H
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 1:2080 CENTURY PARK E STE 401
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90067-2007
Mailing Address - Country:US
Mailing Address - Phone:310-289-0009
Mailing Address - Fax:844-331-1307
Practice Address - Street 1:2080 CENTURY PARK E STE 401
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90067
Practice Address - Country:US
Practice Address - Phone:310-289-0009
Practice Address - Fax:844-331-1307
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA77636207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology