Provider Demographics
NPI:1770910192
Name:KIM, CHRISTINE YOUNG (NP)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:YOUNG
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 1:2020 E. IMPERIAL HWY W/S25/C310
Mailing Address - Street 2:
Mailing Address - City:EL SEGUNDO
Mailing Address - State:CA
Mailing Address - Zip Code:90245-3507
Mailing Address - Country:US
Mailing Address - Phone:310-416-3832
Mailing Address - Fax:310-662-5534
Practice Address - Street 1:2020 E IMPERIAL HWY # S25C310
Practice Address - Street 2:
Practice Address - City:EL SEGUNDO
Practice Address - State:CA
Practice Address - Zip Code:90245-3507
Practice Address - Country:US
Practice Address - Phone:310-416-3832
Practice Address - Fax:310-662-5534
Is Sole Proprietor?:No
Enumeration Date:2013-09-30
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA552691363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health