Provider Demographics
NPI:1720521800
Name:KIM, HEE JEONG (DNP, ARNP, FNP-BC)
Entity Type:Individual
Prefix:DR
First Name:HEE JEONG
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:DNP, ARNP, FNP-BC
Other - Prefix:
Other - First Name:HEEJEONG
Other - Middle Name:
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DNP, ARNP,FNP-BC
Mailing Address - Street 1:22618 HIGHWAY 99
Mailing Address - Street 2:STE 106
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-8395
Mailing Address - Country:US
Mailing Address - Phone:425-409-9247
Mailing Address - Fax:206-535-2442
Practice Address - Street 1:22618 HIGHWAY 99
Practice Address - Street 2:STE 106
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-8395
Practice Address - Country:US
Practice Address - Phone:425-409-9247
Practice Address - Fax:206-535-2442
Is Sole Proprietor?:No
Enumeration Date:2016-11-22
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60686040364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1720521800Medicaid
WA1720521800Medicare Oscar/Certification
WA1720521800Medicare NSC