Provider Demographics
NPI:1114341930
Name:KIM, JANET (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:JANET
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 S SAN VICENTE BLVD # A6600
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-3311
Mailing Address - Country:US
Mailing Address - Phone:310-423-7900
Mailing Address - Fax:424-315-2222
Practice Address - Street 1:127 S SAN VICENTE BLVD # A6600
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-3311
Practice Address - Country:US
Practice Address - Phone:310-423-7900
Practice Address - Fax:424-315-2222
Is Sole Proprietor?:No
Enumeration Date:2014-02-13
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA23267363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant