Healthcare Provider Details

I. General information

NPI: 1306247283
Provider Name (Legal Business Name): SOFIA KIM FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2014
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13800 BIOLA AVE
LA MIRADA CA
90639-0002
US

IV. Provider business mailing address

313 N ORANGE AVE
FULLERTON CA
92833-2412
US

V. Phone/Fax

Practice location:
  • Phone: 562-903-4841
  • Fax: 562-906-4515
Mailing address:
  • Phone: 443-631-1283
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR189468
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP95006064
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: