Provider Demographics
NPI:1104181098
Name:KIM, CINDY (MD)
Entity Type:Individual
Prefix:DR
First Name:CINDY
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4101 TORRANCE BLVD
Mailing Address - Street 2:PROVIDENCE MEDICAL INSTITUTE
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-4607
Mailing Address - Country:US
Mailing Address - Phone:310-543-7025
Mailing Address - Fax:310-543-7090
Practice Address - Street 1:4101 TORRANCE BLVD
Practice Address - Street 2:PROVIDENCE MEDICAL INSTITUTE
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-1911
Practice Address - Country:US
Practice Address - Phone:310-543-7025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-07
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA131823207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine