Provider Demographics
NPI:1528462694
Name:SOUTHERN CALIFORNIA FOOT AND ANKLE MEDICAL CENTER
Entity type:Organization
Organization Name:SOUTHERN CALIFORNIA FOOT AND ANKLE MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:SANG
Authorized Official - Middle Name:YUP
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:562-606-4519
Mailing Address - Street 1:5451 LA PALMA AVE
Mailing Address - Street 2:SUITE 26
Mailing Address - City:LA PALMA
Mailing Address - State:CA
Mailing Address - Zip Code:90623-1728
Mailing Address - Country:US
Mailing Address - Phone:562-606-4519
Mailing Address - Fax:
Practice Address - Street 1:5451 LA PALMA AVE
Practice Address - Street 2:SUITE 26
Practice Address - City:LA PALMA
Practice Address - State:CA
Practice Address - Zip Code:90623-1728
Practice Address - Country:US
Practice Address - Phone:562-606-4519
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-17
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE5105213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty