Provider Demographics
NPI:1073587572
Name:KIM, JUN YUNG (FNP)
Entity Type:Individual
Prefix:
First Name:JUN
Middle Name:YUNG
Last Name:KIM
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2925 SYCAMORE DR
Mailing Address - Street 2:SUITE 204/205
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-1207
Mailing Address - Country:US
Mailing Address - Phone:805-578-9620
Mailing Address - Fax:805-955-0498
Practice Address - Street 1:2925 SYCAMORE DR
Practice Address - Street 2:SUITE 204/205
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-1207
Practice Address - Country:US
Practice Address - Phone:805-578-9620
Practice Address - Fax:805-955-0498
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12763363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARN493960Medicaid
WNP12763AOtherMEDICARE PTAN