Provider Demographics
NPI:1952875098
Name:GRACE KIM AUSTIN MD INC
Entity Type:Organization
Organization Name:GRACE KIM AUSTIN MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:K
Authorized Official - Last Name:AUSTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:747-203-7750
Mailing Address - Street 1:3527 OCEAN VIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91208-1211
Mailing Address - Country:US
Mailing Address - Phone:747-203-7750
Mailing Address - Fax:818-659-7694
Practice Address - Street 1:3527 OCEAN VIEW BLVD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91208-1211
Practice Address - Country:US
Practice Address - Phone:747-203-7750
Practice Address - Fax:818-659-7694
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-11
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Single Specialty