Provider Demographics
NPI:1043924335
Name:101 FOOT AND ANKLE INC.
Entity Type:Organization
Organization Name:101 FOOT AND ANKLE INC.
Other - Org Name:ALICE J. KIM DPM
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:JEN
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:805-200-6994
Mailing Address - Street 1:5016 VIA CUPERTINO
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93012-5240
Mailing Address - Country:US
Mailing Address - Phone:805-200-6994
Mailing Address - Fax:
Practice Address - Street 1:450 ROSEWOOD AVE STE 104
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-5914
Practice Address - Country:US
Practice Address - Phone:805-200-6994
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-11
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty