Provider Demographics
NPI:1629737507
Name:KIM, EUJEAN THOMAS (RN)
Entity Type:Individual
Prefix:
First Name:EUJEAN
Middle Name:THOMAS
Last Name:KIM
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15088 MEADOW OAK PL
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93907-1114
Mailing Address - Country:US
Mailing Address - Phone:831-537-8713
Mailing Address - Fax:
Practice Address - Street 1:655 PARK CENTER DR
Practice Address - Street 2:
Practice Address - City:SANTEE
Practice Address - State:CA
Practice Address - Zip Code:92071-6957
Practice Address - Country:US
Practice Address - Phone:619-596-5500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-08
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility