Basic Information
| Provider Information | |||||||||
| NPI: | 1841622214 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KIM | ||||||||
| FirstName: | SUN | ||||||||
| MiddleName: | HUI | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9920 TALBERT AVE | ||||||||
| Address2: | |||||||||
| City: | FOUNTAIN VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927085153 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7143787000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 9920 TALBERT AVE | ||||||||
| Address2: | |||||||||
| City: | FOUNTAIN VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927085153 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7143787000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/07/2013 | ||||||||
| LastUpdateDate: | 08/07/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | 851414 | CA | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.