Provider Demographics
NPI:1760265367
Name:KIM, ASHLEY
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3345 WILSHIRE BLVD APT 813
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-1818
Mailing Address - Country:US
Mailing Address - Phone:818-389-2601
Mailing Address - Fax:
Practice Address - Street 1:433 N CAMDEN DR STE 805
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4412
Practice Address - Country:US
Practice Address - Phone:310-550-7661
Practice Address - Fax:310-550-1920
Is Sole Proprietor?:No
Enumeration Date:2023-08-16
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant