Sang Il Kim M.D. a Professional Corporation

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

C42314 Issued in CA

Legal business name

SANG IL KIM M.D. A PROFESSIONAL CORPORATION

Practice address

12610 Ventura Blvd
Studio City, CA 91604-2414

Phone

(818) 505-0053

Fax

(818) 505-0343

NPI assigned

Oct 25, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Sang Il Kim, M.D.

Title

Owner

Phone

(818) 505-0053

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1351123200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678147200000",
    "number": "1306199450",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12610 VENTURA BLVD",
            "city": "STUDIO CITY",
            "state": "CA",
            "postal_code": "916042414",
            "telephone_number": "818-505-0053",
            "fax_number": "818-505-0343"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12610 VENTURA BLVD",
            "city": "STUDIO CITY",
            "state": "CA",
            "postal_code": "916042414",
            "telephone_number": "818-505-0053",
            "fax_number": "818-505-0343"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SANG IL KIM M.D. A PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-25",
        "last_updated": "2023-03-07",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "SANG",
        "authorized_official_middle_name": "IL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "818-505-0053",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "C42314",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in Studio City, CA
• Providers in Studio City, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.