Individual
EUGENE L KIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
13652 CANTARA ST, PANORAMA CITY, CA 91402-5423
(703) 362-2029
Mailing address
13652 CANTARA ST, PANORAMA CITY, CA 91402-5423
(703) 362-2029
Taxonomy
Speciality
Code
Description
License number
State
207QA0505X
Adult Medicine Physician
Primary
A125087
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1831350024
—
VA
01
—
372703
ANTHEM
—
01
—
541131672006
TRICARE
—
01
—
P00789316
MEDICARE RAILROAD CARRIER
—
Enumeration date
06/19/2008
Last updated
02/22/2017
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