Provider Demographics
NPI:1417718206
Name:KIM, EUN YOUNG (AGACNP-BC)
Entity Type:Individual
Prefix:
First Name:EUN
Middle Name:YOUNG
Last Name:KIM
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1812 VERDUGO BLVD
Mailing Address - Street 2:PATIENT AND FAMILY SERVICES
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91208
Mailing Address - Country:US
Mailing Address - Phone:818-952-2285
Mailing Address - Fax:818-952-3526
Practice Address - Street 1:1812 VERDUGO BLVD
Practice Address - Street 2:PATIENT AND FAMILY SERVICES
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91208
Practice Address - Country:US
Practice Address - Phone:818-952-2285
Practice Address - Fax:818-952-3526
Is Sole Proprietor?:No
Enumeration Date:2024-01-18
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95028568363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care