MEDICARE: MICHELLE KIM

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	163W00000X	Registered Nurse	95212623	CA
2	367500000X	Certified Registered Nurse Anesthetist	APRN.CRNA.0021444	OH

General Provider Information

NPI Number	:	1871274142
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE KIM

Provider Business Mailing Address
First Line	:	514 N CATALINA AVE
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91106-1000
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11333 CORNELL PARK DR STE 100
Second Line	:
City	:	BLUE ASH
State	:	OH
Zip	:	45242-1813
Country	:	US
Telephone Number	:	513-751-6667
Fax Number	:	513-872-4553

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

Provider Enumeration Date	:	07/28/2023
Last Update Date	:	01/13/2026

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Directions to “ MICHELLE KIM ” Practice Location

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