Provider Demographics
NPI:1275641466
Name:K I MEDICAL GROUP
Entity Type:Organization
Organization Name:K I MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KENJI
Authorized Official - Middle Name:
Authorized Official - Last Name:IRIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:213-617-0266
Mailing Address - Street 1:420 E 3RD ST
Mailing Address - Street 2:SUITE 903
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90013
Mailing Address - Country:US
Mailing Address - Phone:213-617-0266
Mailing Address - Fax:213-617-7332
Practice Address - Street 1:420 E 3RD ST
Practice Address - Street 2:SUITE 903
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90013
Practice Address - Country:US
Practice Address - Phone:213-617-0266
Practice Address - Fax:213-617-7332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW18508Medicare ID - Type Unspecified