Provider Demographics
NPI:1801971478
Name:KIM, KYOUNG CHOL (MD)
Entity type:Individual
Prefix:DR
First Name:KYOUNG
Middle Name:CHOL
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:K.
Other - Middle Name:CHARLES
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2970 W OLYMPIC BLVD
Mailing Address - Street 2:SUITE 204 & 205
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-2518
Mailing Address - Country:US
Mailing Address - Phone:213-382-4900
Mailing Address - Fax:213-382-4909
Practice Address - Street 1:2970 W OLYMPIC BLVD
Practice Address - Street 2:SUITE 204 & 205
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-2518
Practice Address - Country:US
Practice Address - Phone:213-382-4900
Practice Address - Fax:213-382-4909
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA843282086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery