Provider Demographics
NPI:1760719348
Name:KIM, HANA (PA-C)
Entity Type:Individual
Prefix:
First Name:HANA
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 NC HIGHWAY 55 WEST
Mailing Address - Street 2:
Mailing Address - City:MOUNT OLIVE
Mailing Address - State:NC
Mailing Address - Zip Code:28365
Mailing Address - Country:US
Mailing Address - Phone:919-658-5900
Mailing Address - Fax:919-658-0101
Practice Address - Street 1:325 NC HIGHWAY 55 WEST
Practice Address - Street 2:
Practice Address - City:MOUNT OLIVE
Practice Address - State:NC
Practice Address - Zip Code:28365
Practice Address - Country:US
Practice Address - Phone:919-658-5900
Practice Address - Fax:919-658-0101
Is Sole Proprietor?:No
Enumeration Date:2009-11-03
Last Update Date:2012-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-01991363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical