Healthcare Provider Details

I. General information

NPI: 1265210819
Provider Name (Legal Business Name): SUNGHUI KIM FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2023
Last Update Date: 10/06/2025
Certification Date: 10/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2760 FLETCHER PKWY
EL CAJON CA
92020-2110
US

IV. Provider business mailing address

5555 GROSSMONT CENTER DR
LA MESA CA
91942-3019
US

V. Phone/Fax

Practice location:
  • Phone: 619-461-4411
  • Fax:
Mailing address:
  • Phone: 619-740-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95026472
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: