Provider Demographics
NPI:1326377292
Name:KIM SHIN, NAMJU (ACNP-BC)
Entity Type:Individual
Prefix:
First Name:NAMJU
Middle Name:
Last Name:KIM SHIN
Suffix:
Gender:F
Credentials:ACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9896 GARDEN GROVE BLVD
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92844-1643
Mailing Address - Country:US
Mailing Address - Phone:213-388-5144
Mailing Address - Fax:213-388-5154
Practice Address - Street 1:3545 WILSHIRE BLVD STE 247
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-2389
Practice Address - Country:US
Practice Address - Phone:213-388-5144
Practice Address - Fax:213-388-5154
Is Sole Proprietor?:No
Enumeration Date:2009-12-23
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA617461163W00000X
CA18570363LA2100X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care