Provider Demographics
NPI:1922367390
Name:KIM, DELPHINA (CRNP)
Entity Type:Individual
Prefix:
First Name:DELPHINA
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:DELPHINA
Other - Middle Name:KIM
Other - Last Name:PRESTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:325 DISTEL CIR
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-1408
Mailing Address - Country:US
Mailing Address - Phone:831-458-5511
Mailing Address - Fax:
Practice Address - Street 1:2850 COMMERCIAL XING
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95065-1702
Practice Address - Country:US
Practice Address - Phone:831-458-5511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-04
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP012043363LA2200X
CA95001911363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health