Provider Demographics
NPI:1518651744
Name:KIM, ALEXIS JINA (NP)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:JINA
Last Name:KIM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26671 ALISO CREEK RD STE 203
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-4810
Mailing Address - Country:US
Mailing Address - Phone:949-712-7213
Mailing Address - Fax:
Practice Address - Street 1:26671 ALISO CREEK RD STE 203
Practice Address - Street 2:
Practice Address - City:ALISO VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92656-4810
Practice Address - Country:US
Practice Address - Phone:949-712-7213
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-08
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95103057163WC0200X
CA95026206363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine