Healthcare Provider Details

I. General information

NPI: 1477248698
Provider Name (Legal Business Name): ASHLEY ANN KIM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2023
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LOMA LINDA VA CLINIC 26001 REDLANDS BLVD
LOMA LINDA CA
92357-4162
US

IV. Provider business mailing address

26330 LONG ST
LOMA LINDA CA
92354-6565
US

V. Phone/Fax

Practice location:
  • Phone: 909-825-7084
  • Fax:
Mailing address:
  • Phone: 909-544-9760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95031744
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: