Healthcare Provider Details

I. General information

NPI: 1194395053
Provider Name (Legal Business Name): JIHEE KIM FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2021
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5471 LA PALMA AVE STE 200
LA PALMA CA
90623-4702
US

IV. Provider business mailing address

5471 LA PALMA AVE STE 200
LA PALMA CA
90623-4702
US

V. Phone/Fax

Practice location:
  • Phone: 999-999-9999
  • Fax:
Mailing address:
  • Phone: 714-752-6088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95023194
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number95028630
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: