Provider Demographics
NPI:1912225673
Name:KIM, EUGENE (MD)
Entity Type:Individual
Prefix:
First Name:EUGENE
Middle Name:
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 1:4650 SUNSET BLVD, MS #3
Mailing Address - Street 2:CHILDREN'S HOSPIAL LOS ANGELES, DEPT OF ANESTHESIA
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027
Mailing Address - Country:US
Mailing Address - Phone:817-880-6999
Mailing Address - Fax:
Practice Address - Street 1:4650 SUNSET BLVD, MS #3
Practice Address - Street 2:CHILDREN'S HOSPIAL LOS ANGELES, DEPT OF ANESTHESIA
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027
Practice Address - Country:US
Practice Address - Phone:817-880-6999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-05
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA131419207LP3000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP3000XAllopathic & Osteopathic PhysiciansAnesthesiologyPediatric Anesthesiology
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine