Provider Demographics
NPI:1346264595
Name:KIM, EDWARD H (DPM)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:H
Last Name:KIM
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1245 WILSHIRE BLVD STE 810
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90017-4808
Mailing Address - Country:US
Mailing Address - Phone:213-365-1000
Mailing Address - Fax:213-365-2177
Practice Address - Street 1:1245 WILSHIRE BLVD STE 202
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-4810
Practice Address - Country:US
Practice Address - Phone:213-365-1000
Practice Address - Fax:213-365-2177
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2020-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4062213ES0103X
CABK5973842213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery