Provider Demographics
NPI:1467441527
Name:KIM, JOHN S (DPM)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:S
Last Name:KIM
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2137 CESAR CHAVEZ AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033
Mailing Address - Country:US
Mailing Address - Phone:323-262-7450
Mailing Address - Fax:323-262-2337
Practice Address - Street 1:2137 CESAR CHAVEZ AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033
Practice Address - Country:US
Practice Address - Phone:323-262-7450
Practice Address - Fax:323-262-2337
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-20
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4595213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
V03541Medicare UPIN
E4595Medicare ID - Type Unspecified
CA5399730001Medicare NSC