Provider Demographics
NPI:1639141773
Name:KIM, ILKWON (MD)
Entity Type:Individual
Prefix:DR
First Name:ILKWON
Middle Name:
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 1:412 S. WILTON PLACE
Mailing Address - Street 2:UNIT 402
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90020
Mailing Address - Country:US
Mailing Address - Phone:1213-800-1010
Mailing Address - Fax:
Practice Address - Street 1:412 S WILTON PL APT 402
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90020-4586
Practice Address - Country:US
Practice Address - Phone:121-380-0101
Practice Address - Fax:213-800-1010
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC50652208D00000X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD3254925OtherDRIVERS LICENSE