Provider Demographics
NPI:1942575980
Name:K. ALEX KIM, M.D., A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:K. ALEX KIM, M.D., A MEDICAL CORPORATION
Other - Org Name:BROOKS SURGERY CENTER MEDICAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KEYONG-HEE
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-860-9502
Mailing Address - Street 1:9001 WILSHIRE BLVD
Mailing Address - Street 2:202
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-1838
Mailing Address - Country:US
Mailing Address - Phone:310-860-9502
Mailing Address - Fax:310-860-9729
Practice Address - Street 1:9001 WILSHIRE BLVD
Practice Address - Street 2:202
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-1838
Practice Address - Country:US
Practice Address - Phone:310-860-9502
Practice Address - Fax:310-860-9729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-08
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA48949208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF08849Medicare UPIN