Provider Demographics
NPI:1447293733
Name:SIM, JULIE PARK (MD)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:PARK
Last Name:SIM
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 1:3275 SKYPARK DR
Mailing Address - Street 2:STE 4
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-5027
Mailing Address - Country:US
Mailing Address - Phone:310-517-4709
Mailing Address - Fax:
Practice Address - Street 1:3275 SKYPARK DR
Practice Address - Street 2:STE 4
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-5027
Practice Address - Country:US
Practice Address - Phone:310-517-4709
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA802662085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A802660Medicaid
CAWA80266EMedicare PIN
CAWA80266BMedicare PIN
CAWA80266AMedicare PIN
CAI50780Medicare UPIN
CA00A802660Medicaid