Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 95004688 | CA |
NPI | 1003310517 |
---|---|
Provider Name | Ms. Chanyoung Kim |
First Address | Los Angeles, CA 90004-4374 |
Second Address | Los Angeles, CA 90004-4374 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2018 |
Last Update Date | 20/03/2018 |