Provider Demographics
NPI:1457865834
Name:KIM, KYUNG-HWA (CNC)
Entity Type:Individual
Prefix:MISS
First Name:KYUNG-HWA
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:CNC
Other - Prefix:MISS
Other - First Name:MARISOL
Other - Middle Name:
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:775 GUERRERO ST APT 6
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-1693
Mailing Address - Country:US
Mailing Address - Phone:201-916-0373
Mailing Address - Fax:
Practice Address - Street 1:3705 17TH ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94114-2021
Practice Address - Country:US
Practice Address - Phone:201-916-0373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-21
Last Update Date:2017-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist