Provider Demographics
NPI:1891502001
Name:KIM, CHANGKYU
Entity type:Individual
Prefix:
First Name:CHANGKYU
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3185 WILSHIRE BLVD UNIT 783
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-1253
Mailing Address - Country:US
Mailing Address - Phone:213-434-6756
Mailing Address - Fax:323-967-9000
Practice Address - Street 1:9730 WILSHIRE BLVD STE 207
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-2004
Practice Address - Country:US
Practice Address - Phone:213-434-6756
Practice Address - Fax:323-967-9000
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-12
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes342000000XTransportation ServicesTransportation Network Company