Basic Information
| Provider Information | |||||||||
| NPI: | 1386691830 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KIM | ||||||||
| FirstName: | HOWARD | ||||||||
| MiddleName: | HYUKJIN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 99 N LA CIENEGA BLVD STE M102 | ||||||||
| Address2: | |||||||||
| City: | BEVERLY HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902112288 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3103852992 | ||||||||
| FaxNumber: | 3103852973 | ||||||||
| Practice Location | |||||||||
| Address1: | 99 N LA CIENEGA BLVD STE M102 | ||||||||
| Address2: | |||||||||
| City: | BEVERLY HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902112288 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3103852992 | ||||||||
| FaxNumber: | 3103852973 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/30/2006 | ||||||||
| LastUpdateDate: | 07/24/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | A109058 | CA | Y | Allopathic & Osteopathic Physicians | Urology |
ID Information
| ID | Type | State | Issuer | Description | GR0048240 | 05 | CA | MEDICAID |