Provider Demographics
NPI:1952087371
Name:KIM, ARIANA HYUN-YOUNG
Entity type:Individual
Prefix:
First Name:ARIANA
Middle Name:HYUN-YOUNG
Last Name:KIM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16322 LOS ALIMOS ST
Mailing Address - Street 2:
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344-6809
Mailing Address - Country:US
Mailing Address - Phone:213-304-4120
Mailing Address - Fax:
Practice Address - Street 1:5740 RALSTON ST
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-6051
Practice Address - Country:US
Practice Address - Phone:805-477-5700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-22
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker