Provider Demographics
NPI:1508395534
Name:STULL, JAIME KYUNG (MD)
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:KYUNG
Last Name:STULL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34800 BOB WILSON DR
Mailing Address - Street 2:BUILDING 3, FLOOR 3, INTERNAL MEDICINE
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92134-1003
Mailing Address - Country:US
Mailing Address - Phone:619-881-9169
Mailing Address - Fax:619-532-9134
Practice Address - Street 1:34800 BOB WILSON DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92134-4602
Practice Address - Country:US
Practice Address - Phone:619-881-9169
Practice Address - Fax:619-532-9134
Is Sole Proprietor?:No
Enumeration Date:2017-06-04
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA158613207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program