Provider Demographics
NPI:1053475608
Name:JAMES J KIM, M.D., INC
Entity Type:Organization
Organization Name:JAMES J KIM, M.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:J
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:213-386-2500
Mailing Address - Street 1:520 S VIRGIL AVE
Mailing Address - Street 2:SUITE 307
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90020-1416
Mailing Address - Country:US
Mailing Address - Phone:213-386-2500
Mailing Address - Fax:213-386-6787
Practice Address - Street 1:520 S VIRGIL AVE
Practice Address - Street 2:SUITE 307
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90020-1416
Practice Address - Country:US
Practice Address - Phone:213-386-2500
Practice Address - Fax:213-386-6787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA490112084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child NeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A490110Medicaid
CAW18794Medicare PIN
E75047Medicare UPIN