Provider Demographics
NPI:1265764955
Name:JANET S. KIM, M.D. CORP
Entity type:Organization
Organization Name:JANET S. KIM, M.D. CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JANET
Authorized Official - Middle Name:S
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:213-388-7828
Mailing Address - Street 1:500 S VIRGIL AVE
Mailing Address - Street 2:204
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90020-1404
Mailing Address - Country:US
Mailing Address - Phone:213-388-7828
Mailing Address - Fax:213-388-7838
Practice Address - Street 1:500 S VIRGIL AVE
Practice Address - Street 2:204
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90020-1404
Practice Address - Country:US
Practice Address - Phone:213-388-7828
Practice Address - Fax:213-388-7838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-04
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA53915174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A539150Medicaid