Provider Demographics
NPI:1386748325
Name:KIM, MYEONG CHEOL (MD)
Entity type:Individual
Prefix:
First Name:MYEONG
Middle Name:CHEOL
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 1:2140 W OLYMPIC BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-2277
Mailing Address - Country:US
Mailing Address - Phone:213-381-5454
Mailing Address - Fax:213-381-5300
Practice Address - Street 1:2140 W OLYMPIC BLVD STE 210
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-2277
Practice Address - Country:US
Practice Address - Phone:213-381-5454
Practice Address - Fax:213-381-5300
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC50796208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC03014Medicare UPIN