Provider Demographics
NPI:1881852432
Name:KIM, YOUNGWOOK (NP)
Entity Type:Individual
Prefix:MRS
First Name:YOUNGWOOK
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:YOUNG WOOK
Other - Middle Name:
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:28106 RIDGEFOREST CT
Mailing Address - Street 2:
Mailing Address - City:RANCHO PALOS VERDES
Mailing Address - State:CA
Mailing Address - Zip Code:90275-3241
Mailing Address - Country:US
Mailing Address - Phone:310-710-8163
Mailing Address - Fax:
Practice Address - Street 1:3030 W OLYMPIC BLVD
Practice Address - Street 2:#206
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-6501
Practice Address - Country:US
Practice Address - Phone:213-322-2666
Practice Address - Fax:213-322-2667
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-30
Last Update Date:2016-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANPF17067363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner