Provider Demographics
NPI:1700992534
Name:KIM, DAVID O (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:O
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3440 LOMITA BLVD
Mailing Address - Street 2:SUITE #446
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-4801
Mailing Address - Country:US
Mailing Address - Phone:310-326-2828
Mailing Address - Fax:310-326-4817
Practice Address - Street 1:3440 LOMITA BLVD
Practice Address - Street 2:SUITE #446
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-4801
Practice Address - Country:US
Practice Address - Phone:310-326-2828
Practice Address - Fax:310-326-4817
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA42356174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABK0266987OtherDEA NUMBER
CABK0266987OtherDEA NUMBER