Provider Demographics
NPI:1265521371
Name:CALIFORNIA LUNG ASSOCIATES
Entity type:Organization
Organization Name:CALIFORNIA LUNG ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SUCHA
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:213-977-4949
Mailing Address - Street 1:1245 WILSHIRE BLVD STE 503
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90017-4805
Mailing Address - Country:US
Mailing Address - Phone:213-977-4979
Mailing Address - Fax:213-977-0544
Practice Address - Street 1:1245 WILSHIRE BLVD STE 503
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-4805
Practice Address - Country:US
Practice Address - Phone:213-977-4979
Practice Address - Fax:213-977-0544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0042280Medicaid
CAGR0042280Medicaid