Provider Demographics
NPI:1205845583
Name:KIM, HYUK (DO)
Entity Type:Individual
Prefix:
First Name:HYUK
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:DO
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 8248
Mailing Address - Street 2:
Mailing Address - City:LA CRESCENTA
Mailing Address - State:CA
Mailing Address - Zip Code:91224-0248
Mailing Address - Country:US
Mailing Address - Phone:818-890-5300
Mailing Address - Fax:818-890-0880
Practice Address - Street 1:13563 VAN NUYS BLVD
Practice Address - Street 2:
Practice Address - City:PACOIMA
Practice Address - State:CA
Practice Address - Zip Code:91331-3029
Practice Address - Country:US
Practice Address - Phone:818-890-5300
Practice Address - Fax:818-890-0880
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A7982207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX79820Medicaid
CA9423834OtherPIN