Provider Demographics
NPI:1023487634
Name:KIM FOOT AND ANKLE MEDICAL CENTERS OF LONG BEACH, INC
Entity type:Organization
Organization Name:KIM FOOT AND ANKLE MEDICAL CENTERS OF LONG BEACH, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:S.
Authorized Official - Middle Name:DON
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:562-426-2551
Mailing Address - Street 1:2980 N BEVERLY GLEN CIR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90077-1726
Mailing Address - Country:US
Mailing Address - Phone:310-943-4180
Mailing Address - Fax:888-431-8819
Practice Address - Street 1:701 E 28TH ST STE 111
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-2715
Practice Address - Country:US
Practice Address - Phone:562-426-2551
Practice Address - Fax:888-431-8819
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KIM FOOT AND ANKLE MEDICAL CENTERS OF LONG BEACH, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-09-24
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3800332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site