Healthcare Provider Details

I. General information

NPI: 1881320638
Provider Name (Legal Business Name): JANE KIM PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2022
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 SUNNY CREST DR STE 2800
FULLERTON CA
92835-3641
US

IV. Provider business mailing address

1950 SUNNY CREST DR STE 2800
FULLERTON CA
92835-3641
US

V. Phone/Fax

Practice location:
  • Phone: 657-888-9919
  • Fax: 657-888-9941
Mailing address:
  • Phone: 657-888-9919
  • Fax: 657-888-9941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA62993
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: