Provider Demographics
NPI:1134475510
Name:KIM, JOHNATHAN YOON-YOUNG (LVN)
Entity Type:Individual
Prefix:
First Name:JOHNATHAN
Middle Name:YOON-YOUNG
Last Name:KIM
Suffix:
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1351 WEEBURN RD APT 74E
Mailing Address - Street 2:
Mailing Address - City:SEAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90740-3940
Mailing Address - Country:US
Mailing Address - Phone:714-232-9185
Mailing Address - Fax:
Practice Address - Street 1:1351 WEEBURN RD APT 74E
Practice Address - Street 2:
Practice Address - City:SEAL BEACH
Practice Address - State:CA
Practice Address - Zip Code:90740-3940
Practice Address - Country:US
Practice Address - Phone:714-232-9185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-03
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN241963164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse