Provider Demographics
NPI:1407927908
Name:KIM, HAEJIN REBECCA (PA)
Entity Type:Individual
Prefix:MS
First Name:HAEJIN
Middle Name:REBECCA
Last Name:KIM
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:HAEJIN
Other - Middle Name:REBECCA
Other - Last Name:JUN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:500 JEFFERSON BLVD STE B180
Mailing Address - Street 2:
Mailing Address - City:WEST SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95605-2394
Mailing Address - Country:US
Mailing Address - Phone:916-403-2900
Mailing Address - Fax:
Practice Address - Street 1:500 JEFFERSON BLVD STE B180
Practice Address - Street 2:
Practice Address - City:WEST SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95605-2394
Practice Address - Country:US
Practice Address - Phone:916-403-2900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA18683363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant