Provider Demographics
NPI:1508889064
Name:KIM, DOSUN (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MRS
First Name:DOSUN
Middle Name:
Last Name:KIM
Suffix:
Gender:
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 1:429 N STORY PL
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-2606
Mailing Address - Country:US
Mailing Address - Phone:626-522-2206
Mailing Address - Fax:
Practice Address - Street 1:8399 GARVEY AVE
Practice Address - Street 2:
Practice Address - City:ROSEMEAD
Practice Address - State:CA
Practice Address - Zip Code:91770-2650
Practice Address - Country:US
Practice Address - Phone:888-530-4415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP15999363LA2100X, 363LA2100X
CA581800163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse