Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 95008286 | CA |
NPI | 1033618509 |
---|---|
Provider Name | Honggyun Kim |
First Address | Los Angeles, CA 90033-2458 |
Second Address | Los Angeles, CA 90020-5108 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/02/2018 |
Last Update Date | 09/02/2018 |