KYOUNG JIN KIM (NPI# 1609392919) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1609392919 |
| Entity Type | Individual |
| Full Name | KYOUNG JIN KIM |
| Credential | AGNP-BC |
| Practice Address |
15435 S Western Ave Ste 201 Gardena CA 90249-4324 |
| Mailing Address |
3185 Wilshire Blvd Unit 744 Los Angeles CA 90010-1252 |
| Practice Telephone | 2132157323 |
| Enumeration Date | 2017-08-17 |
| Last Update Date | 2017-08-17 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 163WC0200X |
Registered Nurse Specialization: Critical Care Medicine |
714565 | CA | Nursing Service Providers |
| N | 363LA2200X |
Nurse Practitioner Specialization: Adult Health |
NP95006053 | CA | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363LG0600X |
Nurse Practitioner Specialization: Gerontology |
NP95006053 | CA | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 363LP2300X |
Nurse Practitioner Specialization: Primary Care |
NP95006053 | CA | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
15435 S WESTERN AVE STE 201 |
| City | GARDENA |
| State | CA |
| Zip Code | 90249-4324 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720581382 | Suk Medical Clinic Inc | Internal Medicine | 15435 S Western Ave Ste 201, Gardena, CA 90249-4324 | 2018-03-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821518085 | Jin Taek Limb | Chiropractor | 2911 W 135th Pl, Gardena, CA 90249 | 2017-06-20 |
| 1083084651 | Charde Antoinette | Home Health | 2923 W 138th, Gardena, CA 90249 | 2015-09-25 |
| 1316330145 | Lupita Martinez | Marriage & Family Therapist | 15120 Atkinson Ave Ste 7, Gardena, CA 90249 | 2015-03-18 |
| 1699100487 | Asian American Drug Abuse Program, Inc | Community/Behavioral Health | 14112 S. Kingsley Dr., Gardena, CA 90249 | 2013-09-11 |
| 1992142327 | Vin'ash Coaching, LLC | Private Vehicle | 3163 W 154th Place, Gardena, CA 90249 | 2013-05-24 |
| 1811287048 | Best-option Home Health Agency Inc. | Home Health | 15223 S Crenshaw Blvd Suite A, Gardena, CA 90249 | 2011-04-08 |
| 1356644439 | Ameripride Ambulance Service, Inc. | Ambulance | 13509 South Raymond Avenue, Gardena, CA 90249 | 2010-12-13 |
| 1164732327 | Ctc Healthcare Services Inc | In Home Supportive Care | 13108 Arcturus Avenue, Gardena, CA 90249 | 2010-10-20 |
| 1407170996 | Marl Soon Chung | Dentist | 15622 S. Crenshaw Blvd #b, Gardena, CA 90249 | 2010-03-26 |
| 1164677464 | Grace Jiyoung Park | Family Medicine | 15446 S. Western Ave, Southern California Permanente Medical Group, Gardena, CA 90249 | 2008-12-01 |
| Find all providers in zip 90249 | ||||
| Taxonomy Code | 363LP2300X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Primary Care |
| Definition to come... |
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|---|---|---|---|---|
| 1235738782 | Peninsula Healthcare Center | Nurse Practitioner | 22330 Hawthorne Blvd Ste 208, Torrance, CA 90505-2536 | 2020-10-25 |
| 1710584008 | Venessa Beck | Nurse Practitioner | 903 Cardiff St, San Diego, CA 92114-5019 | 2020-10-08 |
| 1053918094 | Janel Nicole Sanglerat | Nurse Practitioner | 416 Aviation Blvd, Santa Rosa, CA 95403-1032 | 2020-10-02 |
| 1790382760 | Christopher Tran | Nurse Practitioner | 11441 Heacock St Ste F, Moreno Valley, CA 92557-7907 | 2020-10-02 |
| 1487266292 | Mollie Shira Hudson | Nurse Practitioner | 14 Whitmore Pl Apt 15, Oakland, CA 94611-4635 | 2020-08-21 |
| 1962014381 | Mario Javier Herrera | Nurse Practitioner | 2130 High Pointe Dr, Apt 108, Corona, CA 92879 | 2020-08-18 |
| 1952912131 | Norman Ivan Kier | Nurse Practitioner | 3834 Edison Ave, Sacramento, CA 95821-2728 | 2020-08-12 |
| 1942811377 | Thanhan Mathews | Nurse Practitioner | 114 W Cameron St Apt B, Hanford, CA 93230-2965 | 2020-08-10 |
| 1972113355 | Marine Mary Kademyan | Nurse Practitioner | 6528 Babcock Ave, North Hollywood, CA 91606 | 2020-07-31 |
| 1245849645 | Shannon Pereira | Nurse Practitioner | 2368 Honeysuckle Way, Hemet, CA 92545-4796 | 2020-07-31 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.