Provider Demographics
NPI:1588832950
Name:KIM, JEEHYE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:JEEHYE
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1491 E LA PALMA AVE
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92805-1564
Mailing Address - Country:US
Mailing Address - Phone:714-535-3330
Mailing Address - Fax:714-535-4332
Practice Address - Street 1:1491 E LA PALMA AVE
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-1564
Practice Address - Country:US
Practice Address - Phone:714-535-3330
Practice Address - Fax:714-535-4332
Is Sole Proprietor?:No
Enumeration Date:2008-02-19
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21314363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily