Provider Demographics
NPI:1154433258
Name:KIM, YEUN HEE (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:YEUN
Middle Name:HEE
Last Name:KIM
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2030 W PICO BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-5011
Mailing Address - Country:US
Mailing Address - Phone:213-389-4544
Mailing Address - Fax:213-389-4554
Practice Address - Street 1:2030 W PICO BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-5011
Practice Address - Country:US
Practice Address - Phone:213-389-4544
Practice Address - Fax:213-389-4554
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP7102363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00054706OtherRAILROAD MEDICARE
CAWNP7102FMedicare ID - Type Unspecified
CAWNP7102EMedicare ID - Type Unspecified
CAP00054706OtherRAILROAD MEDICARE
CAWNP7102AMedicare ID - Type Unspecified
CAWNP7102DMedicare ID - Type Unspecified