Healthcare Provider Details

I. General information

NPI: 1851235188
Provider Name (Legal Business Name): MIN SEOK KIM NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2026
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9555 FIRESTONE BLVD APT I
DOWNEY CA
90241-5587
US

IV. Provider business mailing address

9555 FIRESTONE BLVD APT I
DOWNEY CA
90241-5587
US

V. Phone/Fax

Practice location:
  • Phone: 213-247-0262
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95037975
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: