Provider Demographics
NPI:1952320574
Name:KIM, DAVID SOO HYUN (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:SOO HYUN
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1808 VERDUGO BLVD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91208-1412
Mailing Address - Country:US
Mailing Address - Phone:818-791-7611
Mailing Address - Fax:818-952-5634
Practice Address - Street 1:1808 VERDUGO BLVD
Practice Address - Street 2:SUITE 206
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91208-1412
Practice Address - Country:US
Practice Address - Phone:818-791-7611
Practice Address - Fax:818-952-5634
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA79690207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWA79690EMedicare ID - Type UnspecifiedMONTEREY PARK OFFICE
CAH72028Medicare UPIN
CAWA79690CMedicare ID - Type UnspecifiedWEST HILLS OFFICE
CAWA79690DMedicare ID - Type UnspecifiedGLENDALE OFFICE