Provider Demographics
NPI:1811543143
Name:KIM, MIN JOO (PA-C, MPH)
Entity Type:Individual
Prefix:MR
First Name:MIN JOO
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:PA-C, MPH
Other - Prefix:MR
Other - First Name:KEVIN
Other - Middle Name:
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C, MPH
Mailing Address - Street 1:5832 BEACH BLVD UNIT 209
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90621-5501
Mailing Address - Country:US
Mailing Address - Phone:714-676-5541
Mailing Address - Fax:
Practice Address - Street 1:5832 BEACH BLVD UNIT 209
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90621-5501
Practice Address - Country:US
Practice Address - Phone:714-676-5541
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-13
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical