Provider Demographics
NPI:1780698340
Name:LE, KIM CHI (MD)
Entity type:Individual
Prefix:MRS
First Name:KIM
Middle Name:CHI
Last Name:LE
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1414 S GRAND AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90015-3071
Mailing Address - Country:US
Mailing Address - Phone:213-259-2299
Mailing Address - Fax:213-481-7023
Practice Address - Street 1:1414 S GRAND AVE STE 100
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90015
Practice Address - Country:US
Practice Address - Phone:213-259-2299
Practice Address - Fax:213-481-7023
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2018-09-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA61348207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A613480Medicaid
WA61348AMedicare ID - Type Unspecified
CA00A613480Medicaid