Basic Information
| Provider Information | |||||||||
| NPI: | 1922398015 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KIM | ||||||||
| FirstName: | SOOJIN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3401 W SUNFLOWER AVE | ||||||||
| Address2: | SUITE 250 | ||||||||
| City: | SANTA ANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927046948 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7146198777 | ||||||||
| FaxNumber: | 7146405051 | ||||||||
| Practice Location | |||||||||
| Address1: | 3401 W SUNFLOWER AVE | ||||||||
| Address2: | SUITE 250 | ||||||||
| City: | SANTA ANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927046948 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7146198777 | ||||||||
| FaxNumber: | 7146405051 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2011 | ||||||||
| LastUpdateDate: | 04/11/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 533833 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.