Provider Demographics
NPI:1396021853
Name:KIM, HYO JUNG (NP)
Entity Type:Individual
Prefix:
First Name:HYO
Middle Name:JUNG
Last Name:KIM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:HYO
Other - Middle Name:JUNG
Other - Last Name:SUH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:8327 DAVIS ST STE 202
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90241-4998
Mailing Address - Country:US
Mailing Address - Phone:562-923-2445
Mailing Address - Fax:
Practice Address - Street 1:8327 DAVIS ST STE 202
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-4998
Practice Address - Country:US
Practice Address - Phone:562-923-2445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-28
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19929363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics