Provider Demographics
NPI:1376655084
Name:MYEONG CHEOL KIM, M.D., INC.
Entity Type:Organization
Organization Name:MYEONG CHEOL KIM, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MYEONG
Authorized Official - Middle Name:CHEOL
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:213-381-5454
Mailing Address - Street 1:2140 W OLYMPIC BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-2277
Mailing Address - Country:US
Mailing Address - Phone:213-381-5454
Mailing Address - Fax:213-381-5300
Practice Address - Street 1:2140 W OLYMPIC BLVD STE 210
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-2277
Practice Address - Country:US
Practice Address - Phone:213-381-5454
Practice Address - Fax:213-381-5300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC50796208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW16392Medicare ID - Type Unspecified