Healthcare Provider Details

I. General information

NPI: 1386084333
Provider Name (Legal Business Name): JIEUN KIM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ESTHER KIM NP

II. Dates (important events)

Enumeration Date: 07/03/2013
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 DISTEL CIR
LOS ALTOS CA
94022-1408
US

IV. Provider business mailing address

325 DISTEL CIR
LOS ALTOS CA
94022-1408
US

V. Phone/Fax

Practice location:
  • Phone: 510-490-1222
  • Fax:
Mailing address:
  • Phone: 510-490-1222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number95005505
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberF382424
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: