Provider Demographics
NPI:1861415820
Name:KIM, CECILIA SUE-YOUN (MD)
Entity type:Individual
Prefix:
First Name:CECILIA
Middle Name:SUE-YOUN
Last Name:KIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8203 HANNUM AVE
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-6171
Mailing Address - Country:US
Mailing Address - Phone:310-613-4945
Mailing Address - Fax:310-390-4945
Practice Address - Street 1:11301 WILSHIRE BLVD
Practice Address - Street 2:MAIL CODE 111H
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90073-1003
Practice Address - Country:US
Practice Address - Phone:310-268-3622
Practice Address - Fax:310-268-4508
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG74909207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G749090OtherMEDICAL PPIN #
CAWG74909CMedicare ID - Type UnspecifiedPPIN #
CA00G749090OtherMEDICAL PPIN #
CAWG74909BMedicare ID - Type UnspecifiedPPIN #