Provider Demographics
NPI:1194891887
Name:KIM, WHAN SIL (MD)
Entity type:Individual
Prefix:
First Name:WHAN
Middle Name:SIL
Last Name:KIM
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:5042 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 620
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90036-4305
Mailing Address - Country:US
Mailing Address - Phone:213-384-0077
Mailing Address - Fax:213-384-2077
Practice Address - Street 1:7825 ENGINEER RD
Practice Address - Street 2:SUITE 101
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-1924
Practice Address - Country:US
Practice Address - Phone:858-277-7111
Practice Address - Fax:858-277-7667
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2011-01-03
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Provider Licenses
StateLicense IDTaxonomies
CAA35061207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA84728Medicare UPIN
CAA35061Medicare PIN