Provider Demographics
NPI:1043779986
Name:KIM, UNJA
Entity Type:Individual
Prefix:
First Name:UNJA
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 1:7910 FROST ST STE 140
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-2712
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7910 FROST ST STE 140
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-2712
Practice Address - Country:US
Practice Address - Phone:858-966-6767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-19
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA691016163WX0002X
CA235962176B00000X
CA813362085U0001X
CA95009688363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163WX0002XNursing Service ProvidersRegistered NurseObstetric, High-Risk
No176B00000XOther Service ProvidersMidwife
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound