Provider Demographics
NPI:1245422724
Name:KIM, MARY-MARGARET SHAFFER (MD)
Entity Type:Individual
Prefix:
First Name:MARY-MARGARET
Middle Name:SHAFFER
Last Name:KIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:MARGARET
Other - Last Name:SHAFFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:910 VIA DE LA PAZ
Mailing Address - Street 2:SUITE 207
Mailing Address - City:PACIFIC PALISADES
Mailing Address - State:CA
Mailing Address - Zip Code:90272-3515
Mailing Address - Country:US
Mailing Address - Phone:310-454-4466
Mailing Address - Fax:310-454-0916
Practice Address - Street 1:910 VIA DE LA PAZ
Practice Address - Street 2:SUITE 207
Practice Address - City:PACIFIC PALISADES
Practice Address - State:CA
Practice Address - Zip Code:90272-3515
Practice Address - Country:US
Practice Address - Phone:310-454-4466
Practice Address - Fax:310-454-0916
Is Sole Proprietor?:No
Enumeration Date:2007-08-17
Last Update Date:2007-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA99884208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics