Provider Demographics
NPI:1235388760
Name:KIMS FOOT & ANKLE CLINIC INC.
Entity Type:Organization
Organization Name:KIMS FOOT & ANKLE CLINIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:213-380-7888
Mailing Address - Street 1:2727 W OLYMPIC BLVD
Mailing Address - Street 2:#100
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-2637
Mailing Address - Country:US
Mailing Address - Phone:213-380-7888
Mailing Address - Fax:213-380-7884
Practice Address - Street 1:2727 W OLYMPIC BLVD
Practice Address - Street 2:#100
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-2637
Practice Address - Country:US
Practice Address - Phone:213-380-7888
Practice Address - Fax:213-380-7884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-09
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4040213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty