Provider Demographics
NPI:1043666795
Name:KIM, YAEHEE
Entity Type:Individual
Prefix:
First Name:YAEHEE
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 S COMMONWEALTH AVE
Mailing Address - Street 2:APT#1
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90020-1225
Mailing Address - Country:US
Mailing Address - Phone:714-453-8753
Mailing Address - Fax:
Practice Address - Street 1:410 S COMMONWEALTH AVE
Practice Address - Street 2:APT#1
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90020-1225
Practice Address - Country:US
Practice Address - Phone:714-453-8753
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-12
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95004191363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily