Provider Demographics
NPI:1720089618
Name:KIM, YOUNGMI P (NP)
Entity Type:Individual
Prefix:
First Name:YOUNGMI
Middle Name:P
Last Name:KIM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1835 EL CAJON BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-2591
Mailing Address - Country:US
Mailing Address - Phone:619-692-3977
Mailing Address - Fax:
Practice Address - Street 1:1835 EL CAJON BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-2591
Practice Address - Country:US
Practice Address - Phone:619-692-3977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CANP13780363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAQ22620Medicare UPIN