Provider Demographics
NPI:1003011677
Name:KIM, JI YEON (MD, MPH)
Entity type:Individual
Prefix:
First Name:JI YEON
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11668 SHERMAN WAY
Mailing Address - Street 2:ADMIN
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91605-5831
Mailing Address - Country:US
Mailing Address - Phone:818-503-6710
Mailing Address - Fax:
Practice Address - Street 1:11668 SHERMAN WAY
Practice Address - Street 2:ADMIN
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91605-5831
Practice Address - Country:US
Practice Address - Phone:818-503-6710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-15
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA122377207ZP0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine