Healthcare Provider Details

I. General information

NPI: 1174811046
Provider Name (Legal Business Name): ROSE KIM CHANG HULL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2011
Last Update Date: 06/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2823 FRESNO ST
FRESNO CA
93721-1324
US

IV. Provider business mailing address

1524 W LACEY BLVD STE 101
HANFORD CA
93230-5990
US

V. Phone/Fax

Practice location:
  • Phone: 559-499-6439
  • Fax: 559-499-6441
Mailing address:
  • Phone: 559-537-0305
  • Fax: 559-537-0307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN718940
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP20843
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: