Provider Demographics
NPI:1669562757
Name:KIM, EUNJUNG (ARNP)
Entity type:Individual
Prefix:
First Name:EUNJUNG
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1360 NW 201ST ST
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98177
Mailing Address - Country:US
Mailing Address - Phone:206-542-0126
Mailing Address - Fax:
Practice Address - Street 1:33507 9TH AVE S
Practice Address - Street 2:BUILDING A
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-6397
Practice Address - Country:US
Practice Address - Phone:253-874-5404
Practice Address - Fax:253-874-8964
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30006069363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9641986Medicaid
WA9641986Medicaid
WA8869507Medicare PIN