Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 176B00000X | Midwife | 235962 | CA |
Y | 363LW0102X | Nurse Practitioner - Women's Health | 95009688 | CA |
NPI | 1043779986 |
---|---|
Provider Name | Unja Kim |
First Address | San Diego, CA 92123-2712 |
Second Address | San Diego, CA 92123-2712 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2019 |
Last Update Date | 19/03/2019 |