Provider Demographics
NPI:1891371902
Name:KIM, JOANNE YOO (PA-C)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:YOO
Last Name:KIM
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JOANNE
Other - Middle Name:
Other - Last Name:YOO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4255 CAMPUS DRIVE
Mailing Address - Street 2:PO BOX UNIT 6241
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92616
Mailing Address - Country:US
Mailing Address - Phone:818-304-2501
Mailing Address - Fax:
Practice Address - Street 1:1441 AVOCADO AVE STE 503
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7706
Practice Address - Country:US
Practice Address - Phone:949-718-9020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-19
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59213363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant