1578812269 NPI number — SRS KIM INC

Table of content: CONSTANZA GONZALEZ ARANCIBIA NP (NPI 1518789593)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578812269 NPI number — SRS KIM INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SRS KIM INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1578812269
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/10/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5855 GREEN VALLEY CIRCLE.,
Provider Second Line Business Mailing Address:
STE.201
Provider Business Mailing Address City Name:
CULVER CITY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90230
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-266-9760
Provider Business Mailing Address Fax Number:
310-670-1914

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12450 CULVER BLVD
Provider Second Line Business Practice Location Address:
3305
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90066
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-266-9760
Provider Business Practice Location Address Fax Number:
310-670-1914
Provider Enumeration Date:
09/10/2012

Additional Information

Authorized Official

Authorized Official Last Name:
KIM
Authorized Official First Name:
SARAH
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
310-266-9760

Provider Taxonomy Codes

  • Taxonomy code: 171100000X , with the licence number:  10029 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1134224447 . This is a "PERSONAL NPI" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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