Provider Demographics
NPI:1104465541
Name:SAM KIM PHYSICIAN SERVICES INC
Entity type:Organization
Organization Name:SAM KIM PHYSICIAN SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:SUNGWON
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-939-4511
Mailing Address - Street 1:466 FOOTHILL BLVD # 307
Mailing Address - Street 2:
Mailing Address - City:LA CANADA
Mailing Address - State:CA
Mailing Address - Zip Code:91011-3518
Mailing Address - Country:US
Mailing Address - Phone:818-939-4511
Mailing Address - Fax:
Practice Address - Street 1:150 N ROBERTSON BLVD STE 307
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-2145
Practice Address - Country:US
Practice Address - Phone:310-659-8687
Practice Address - Fax:310-659-2420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-02
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty