Provider Demographics
NPI:1588790315
Name:KIM, AMY LYNN (MD)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:LYNN
Last Name:KIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:225 S LAKE AVE STE 535
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-3010
Mailing Address - Country:US
Mailing Address - Phone:626-795-9596
Mailing Address - Fax:626-795-8247
Practice Address - Street 1:100 W CALIFORNIA BLVD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3010
Practice Address - Country:US
Practice Address - Phone:626-397-5000
Practice Address - Fax:626-397-2912
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA102809207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1588790315Medicaid
CA0A1028090OtherBLUE SHIELD
CA1588790315Medicaid