Provider Demographics
NPI:1235420241
Name:KIM, IRENE APRIL (BS)
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:APRIL
Last Name:KIM
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5767 W CENTURY BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-5631
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:200 MEDICAL PLAZA
Practice Address - Street 2:STE 550
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-0000
Practice Address - Country:US
Practice Address - Phone:310-203-6688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-25
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD81188208200000X
CAA126132207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery