Provider Demographics
NPI:1467794255
Name:KIM, SUNGCHAN (RD)
Entity Type:Individual
Prefix:DR
First Name:SUNGCHAN
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12130 PARAMOUNT BLVD
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90242-2339
Mailing Address - Country:US
Mailing Address - Phone:562-923-9414
Mailing Address - Fax:562-923-9451
Practice Address - Street 1:12130 PARAMOUNT BLVD
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90242-2339
Practice Address - Country:US
Practice Address - Phone:562-923-9414
Practice Address - Fax:562-923-9451
Is Sole Proprietor?:No
Enumeration Date:2013-03-20
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL894248133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered