Provider Demographics
NPI:1508408899
Name:KIM, EUNSUN
Entity Type:Individual
Prefix:
First Name:EUNSUN
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 MOWRY AVENUE
Mailing Address - Street 2:SUITE 227
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538
Mailing Address - Country:US
Mailing Address - Phone:510-248-1600
Mailing Address - Fax:510-818-8709
Practice Address - Street 1:2500 MOWRY AVENUE
Practice Address - Street 2:SUITE 227
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538
Practice Address - Country:US
Practice Address - Phone:510-248-1600
Practice Address - Fax:510-818-8709
Is Sole Proprietor?:No
Enumeration Date:2019-10-08
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95009190363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily