Healthcare Provider Details

I. General information

NPI: 1003228115
Provider Name (Legal Business Name): GINNY KIM THAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: GINNY KIM

II. Dates (important events)

Enumeration Date: 05/22/2014
Last Update Date: 05/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4650 W SUNSET BLVD MS #81
LOS ANGELES CA
90027-6062
US

IV. Provider business mailing address

4650 W SUNSET BLVD MS #81
LOS ANGELES CA
90027-6062
US

V. Phone/Fax

Practice location:
  • Phone: 323-361-3033
  • Fax: 323-361-8191
Mailing address:
  • Phone: 323-361-3033
  • Fax: 323-361-8191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number23518
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: