Provider Demographics
NPI:1144371436
Name:KIM, MEE SOOK (MD)
Entity type:Individual
Prefix:DR
First Name:MEE
Middle Name:SOOK
Last Name:KIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:15243 VANOWEN ST
Mailing Address - Street 2:SUITE 504
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405-3605
Mailing Address - Country:US
Mailing Address - Phone:818-781-8972
Mailing Address - Fax:818-781-8990
Practice Address - Street 1:15243 VANOWEN ST
Practice Address - Street 2:SUITE 504
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-3605
Practice Address - Country:US
Practice Address - Phone:818-781-8972
Practice Address - Fax:818-781-8990
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA39215207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A392150Medicaid
CA00A392150Medicaid
CAA39215Medicare ID - Type Unspecified