Provider Demographics
NPI:1649234931
Name:KIM, BENJAMIN B (MD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:B
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:6041 CADILLAC AVE
Mailing Address - Street 2:KAISER PERMANENTE WEST LOS ANGELES MEDICAL CENTER
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-1702
Mailing Address - Country:US
Mailing Address - Phone:323-857-2182
Mailing Address - Fax:323-857-3307
Practice Address - Street 1:6041 CADILLAC AVE
Practice Address - Street 2:KAISER PERMANENTE WEST LOS ANGELES MEDICAL CENTER
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90034-1702
Practice Address - Country:US
Practice Address - Phone:323-857-2182
Practice Address - Fax:323-857-3307
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2021-11-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA73275208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A732750Medicaid
CAH93898Medicare UPIN
CA00A732750Medicare PIN