Basic Information
| Provider Information | |||||||||
| NPI: | 1770097362 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KIM | ||||||||
| FirstName: | JI | ||||||||
| MiddleName: | AH | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 25033 | ||||||||
| Address2: | |||||||||
| City: | SANTA ANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927995033 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7143471010 | ||||||||
| FaxNumber: | 7143471082 | ||||||||
| Practice Location | |||||||||
| Address1: | 1300 N VERMONT AVE | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900276098 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2134133000 | ||||||||
| FaxNumber: | 3236662939 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/20/2017 | ||||||||
| LastUpdateDate: | 10/31/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/31/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WC0200X | 0001214465 | VA | N | Nursing Service Providers | Registered Nurse | Critical Care Medicine | 367500000X | 0024175781 | VA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | 207L00000X | 95001716 | CA | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.