Provider Demographics
NPI:1144208182
Name:KIM, GENE HO (MD)
Entity Type:Individual
Prefix:DR
First Name:GENE
Middle Name:HO
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:PO BOX 31309
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90031-0309
Mailing Address - Country:US
Mailing Address - Phone:323-442-6200
Mailing Address - Fax:
Practice Address - Street 1:1450 SAN PABLO ST STE 2000
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-4500
Practice Address - Country:US
Practice Address - Phone:323-442-6200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA104201207ND0900X, 207ND0900X
IN01062384A207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACG4848OtherMEDICARE RAILROAD GRP ID #
CAGR0101420Medicaid
CAGR0101421Medicaid
CALAB28654FMedicaid
CAZZZ94714ZOtherBLUE SHIELD GROUP ID #
CAZZZ31029ZOtherBLUE SHIELD GROUP ID #
CAZZZ54738ZOtherBLUE SHIELD GROUP ID #
CAW7801BMedicare PIN
CAZZZ54738ZOtherBLUE SHIELD GROUP ID #
CAZZZ31029ZOtherBLUE SHIELD GROUP ID #
INI49698Medicare UPIN
CAHW7801AMedicare PIN
CAZZZ94714ZOtherBLUE SHIELD GROUP ID #