Provider Demographics
NPI:1326260779
Name:KIM, TIMOTHY MANSOO (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:MANSOO
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4937 CROWN AVE
Mailing Address - Street 2:
Mailing Address - City:LA CANADA
Mailing Address - State:CA
Mailing Address - Zip Code:91011-3621
Mailing Address - Country:US
Mailing Address - Phone:818-737-6174
Mailing Address - Fax:818-737-6216
Practice Address - Street 1:8403 FALLBROOK AVE
Practice Address - Street 2:
Practice Address - City:WEST HILLS
Practice Address - State:CA
Practice Address - Zip Code:91304-3226
Practice Address - Country:US
Practice Address - Phone:818-737-6174
Practice Address - Fax:818-737-6216
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA51246207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology