Healthcare Provider Details

I. General information

NPI: 1790526101
Provider Name (Legal Business Name): HYEON JIN KIM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2024
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 E IMPERIAL HWY STE B4
BREA CA
92821-5634
US

IV. Provider business mailing address

13129 BLODGETT AVE
DOWNEY CA
90242-5201
US

V. Phone/Fax

Practice location:
  • Phone: 714-853-2762
  • Fax:
Mailing address:
  • Phone: 678-956-3383
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95030287
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: