Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | A131917 | CA |
N | 207QS0010X | Family Doctor - Sports Medicine | A13197 | CA |
NPI | 1144666272 |
---|---|
Provider Name | Jennifer Kim |
First Address | San Francisco, CA 94111-3723 |
Second Address | Huntington Beach, CA 92647-7647 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2013 |
Last Update Date | 18/02/2021 |