Provider Demographics
NPI:1518124536
Name:KIM, GLORIA SUNG (MD)
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:SUNG
Last Name:KIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5767 W CENTURY BLVD
Mailing Address - Street 2:STE. 365
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-5632
Mailing Address - Country:US
Mailing Address - Phone:310-458-2381
Mailing Address - Fax:310-260-2963
Practice Address - Street 1:2020 SANTA MONICA BLVD
Practice Address - Street 2:STE. 210
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2023
Practice Address - Country:US
Practice Address - Phone:310-458-2381
Practice Address - Fax:310-260-2963
Is Sole Proprietor?:No
Enumeration Date:2008-05-19
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA74176207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A741760Medicaid
CA00A741760Medicaid