Provider Demographics
NPI:1922197227
Name:KUM, HEASOOK (NP)
Entity Type:Individual
Prefix:
First Name:HEASOOK
Middle Name:
Last Name:KUM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 S TUSTIN ST
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92866-3425
Mailing Address - Country:US
Mailing Address - Phone:714-633-6373
Mailing Address - Fax:714-633-1443
Practice Address - Street 1:14372 BEACH BLVD
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-4578
Practice Address - Country:US
Practice Address - Phone:714-891-0955
Practice Address - Fax:714-893-5145
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6320363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARN301720OtherMEDI-CAL