Provider Demographics
NPI:1801819321
Name:KIM, LAUREN SOOJIN (MD)
Entity type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:SOOJIN
Last Name:KIM
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 1:931 BUENA VISTA ST STE 405
Mailing Address - Street 2:
Mailing Address - City:DUARTE
Mailing Address - State:CA
Mailing Address - Zip Code:91010-1723
Mailing Address - Country:US
Mailing Address - Phone:626-358-4862
Mailing Address - Fax:626-739-1305
Practice Address - Street 1:931 BUENA VISTA ST STE 405
Practice Address - Street 2:
Practice Address - City:DUARTE
Practice Address - State:CA
Practice Address - Zip Code:91010-1723
Practice Address - Country:US
Practice Address - Phone:626-358-4862
Practice Address - Fax:626-739-1305
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA79083207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH-88394Medicare UPIN