Provider Demographics
NPI:1699162941
Name:NANCY M KIM INC
Entity type:Organization
Organization Name:NANCY M KIM INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:M
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-287-7455
Mailing Address - Street 1:6520 PLATT AVE
Mailing Address - Street 2:459
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91307-3218
Mailing Address - Country:US
Mailing Address - Phone:818-287-7455
Mailing Address - Fax:818-287-6919
Practice Address - Street 1:11550 INDIANA HILLS RD
Practice Address - Street 2:301
Practice Address - City:MISSION HILLS
Practice Address - State:CA
Practice Address - Zip Code:91345
Practice Address - Country:US
Practice Address - Phone:818-287-7455
Practice Address - Fax:818-287-6919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-23
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA82341207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty