Provider Demographics
NPI:1578799672
Name:KIM, JOYCE HELLEN (PNP)
Entity Type:Individual
Prefix:MRS
First Name:JOYCE
Middle Name:HELLEN
Last Name:KIM
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:MRS
Other - First Name:JOYCE
Other - Middle Name:HELLEN
Other - Last Name:SHIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PNP
Mailing Address - Street 1:13843 DOVE CANYON WAY
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91739-2272
Mailing Address - Country:US
Mailing Address - Phone:909-646-7654
Mailing Address - Fax:
Practice Address - Street 1:805 WEST LAVETA
Practice Address - Street 2:SUITE 103
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868
Practice Address - Country:US
Practice Address - Phone:714-997-8911
Practice Address - Fax:714-997-4911
Is Sole Proprietor?:No
Enumeration Date:2009-06-03
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11840363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics