Provider Demographics
NPI:1023212487
Name:KIM, DOLLY BAHL (MD MBA)
Entity Type:Individual
Prefix:DR
First Name:DOLLY
Middle Name:BAHL
Last Name:KIM
Suffix:
Gender:F
Credentials:MD MBA
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:238 FAIR OAKS AVE
Mailing Address - Street 2:APT J
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91030-1835
Mailing Address - Country:US
Mailing Address - Phone:626-240-4842
Mailing Address - Fax:
Practice Address - Street 1:238 FAIR OAKS AVE
Practice Address - Street 2:APT J
Practice Address - City:SOUTH PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91030-1835
Practice Address - Country:US
Practice Address - Phone:626-240-4842
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301085511207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine