Provider Demographics
NPI:1952477648
Name:WHAN SIL KIM, M.D., INC.
Entity Type:Organization
Organization Name:WHAN SIL KIM, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WHAN
Authorized Official - Middle Name:SIL
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-931-1400
Mailing Address - Street 1:5042 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 620
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90036-4305
Mailing Address - Country:US
Mailing Address - Phone:323-931-1400
Mailing Address - Fax:323-931-2002
Practice Address - Street 1:903 CRENSHAW BLVD
Practice Address - Street 2:SUITE 305
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90019-1964
Practice Address - Country:US
Practice Address - Phone:323-931-1400
Practice Address - Fax:323-931-2002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA35061207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA84728Medicare UPIN
CAA35061Medicare PIN