Basic Information
| Provider Information | |||||||||
| NPI: | 1114212743 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KIM | ||||||||
| FirstName: | ANGELO | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 27404 N. EVAN LN | ||||||||
| Address2: | #102 | ||||||||
| City: | SANTA CLARITA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 91387 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6614345987 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 38600 MEDICAL CENTER DRIVE, | ||||||||
| Address2: | |||||||||
| City: | PALMDALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 93551 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6613825000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2011 | ||||||||
| LastUpdateDate: | 06/25/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 199092 | PA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.