Provider Demographics
NPI:1598439242
Name:KIM, RONALD MINSUNG (CNA)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:MINSUNG
Last Name:KIM
Suffix:
Gender:M
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5500 OWENSMOUTH AVE APT 314
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-7009
Mailing Address - Country:US
Mailing Address - Phone:808-561-7302
Mailing Address - Fax:
Practice Address - Street 1:5500 OWENSMOUTH AVE APT 314
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367-7009
Practice Address - Country:US
Practice Address - Phone:808-561-7302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-05
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide