Provider Demographics
NPI:1497761027
Name:KIM, STEPHEN LYO-SUNG (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:LYO-SUNG
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 S LAKE AVE
Mailing Address - Street 2:535
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-3005
Mailing Address - Country:US
Mailing Address - Phone:626-795-6596
Mailing Address - Fax:626-795-8247
Practice Address - Street 1:1246 W 155TH ST
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90247-4011
Practice Address - Country:US
Practice Address - Phone:310-323-5330
Practice Address - Fax:310-768-2223
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG76433207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G764333OtherBLUE SHIELD
CA00G764330Medicaid
CA00G764333OtherBLUE SHIELD
CAWG76433DMedicare PIN
G06632Medicare UPIN
CAG76433Medicare PIN