Provider Demographics
NPI:1952581738
Name:KIM, JANICE CHIN SUN (NP)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:CHIN SUN
Last Name:KIM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JANICE
Other - Middle Name:CHIN SUN
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:4199 FLAT ROCK DR STE 147
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92505-7115
Mailing Address - Country:US
Mailing Address - Phone:951-760-6209
Mailing Address - Fax:833-694-1500
Practice Address - Street 1:4199 FLAT ROCK DR STE 147
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92505-7115
Practice Address - Country:US
Practice Address - Phone:951-760-6209
Practice Address - Fax:833-694-1500
Is Sole Proprietor?:No
Enumeration Date:2007-11-08
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP17755363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner