Provider Demographics
NPI:1457796179
Name:KIM, HAYUN (ANP-C)
Entity Type:Individual
Prefix:
First Name:HAYUN
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:ANP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 W BASELINE RD
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-6041
Mailing Address - Country:US
Mailing Address - Phone:480-834-9039
Mailing Address - Fax:480-964-7802
Practice Address - Street 1:612 W BASELINE RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210
Practice Address - Country:US
Practice Address - Phone:480-834-9039
Practice Address - Fax:480-964-7802
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-08
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN110675163W00000X
AZAP4723363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse