MEDICARE: JOHNATHAN YOON-YOUNG KIM LVN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164X00000X	Licensed Vocational Nurse	VN241963	CA

General Provider Information

NPI Number	:	1134475510
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHNATHAN YOON-YOUNG KIM LVN

Provider Business Mailing Address
First Line	:	1351 WEEBURN RD APT 74E
Second Line	:
City	:	SEAL BEACH
State	:	CA
Zip	:	90740-3940
Country	:	US
Telephone Number	:	714-232-9185
Fax Number	:

Provider Business Practice Location Address
First Line	:	1351 WEEBURN RD APT 74E
Second Line	:
City	:	SEAL BEACH
State	:	CA
Zip	:	90740-3940
Country	:	US
Telephone Number	:	714-232-9185
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/03/2012
Last Update Date	:	08/03/2012

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