Provider Demographics
NPI:1144228628
Name:KIM, WILLIAM CHUL (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:CHUL
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 1:4201 TORRANCE BLVD
Mailing Address - Street 2:SUITE 190
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-4504
Mailing Address - Country:US
Mailing Address - Phone:310-543-2521
Mailing Address - Fax:310-543-4754
Practice Address - Street 1:4201 TORRANCE BLVD
Practice Address - Street 2:SUITE 190
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-4504
Practice Address - Country:US
Practice Address - Phone:310-543-2521
Practice Address - Fax:310-543-4754
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-08
Last Update Date:2012-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC39809174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA37226Medicare UPIN
CAWC39809FMedicare ID - Type Unspecified
CAWC39809EMedicare ID - Type Unspecified
CAWC39809Medicare ID - Type Unspecified