Provider Demographics
NPI:1700812930
Name:GUY, KIM RENEE (MD)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:RENEE
Last Name:GUY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:267 S SAN PEDRO ST
Mailing Address - Street 2:#124
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90012-3874
Mailing Address - Country:US
Mailing Address - Phone:310-953-5276
Mailing Address - Fax:
Practice Address - Street 1:450 BAUCHET ST DEPT OF
Practice Address - Street 2:JAIL MENTAL HEALTH
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90012-2907
Practice Address - Country:US
Practice Address - Phone:213-974-9077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA720422084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ742800Medicaid
NM90970501Medicaid
TX8HAY58Medicare ID - Type UnspecifiedHSZ003
H71737Medicare UPIN
NM90970501Medicaid
AZ742800Medicaid
TX8HAY56Medicare ID - Type UnspecifiedHSZ001
TX8HAY57Medicare ID - Type UnspecifiedHSZ002