Provider Demographics
NPI:1942427927
Name:KIM, JIYOUNG (NP)
Entity Type:Individual
Prefix:
First Name:JIYOUNG
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JI YOUNG
Other - Middle Name:
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3801 MIRANDA AVE # 171
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94304-1290
Mailing Address - Country:US
Mailing Address - Phone:650-493-5000
Mailing Address - Fax:650-858-8905
Practice Address - Street 1:3801 MIRANDA AVE # 171
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304-1290
Practice Address - Country:US
Practice Address - Phone:650-493-5000
Practice Address - Fax:650-858-8905
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16991363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology