Healthcare Provider Details

I. General information

NPI: 1740696731
Provider Name (Legal Business Name): HANARANG KIM RN, MS, CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2014
Last Update Date: 12/06/2021
Certification Date: 12/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15400 LOS GATOS BLVD
LOS GATOS CA
95032
US

IV. Provider business mailing address

15400 LOS GATOS BLVD
LOS GATOS CA
95032-2502
US

V. Phone/Fax

Practice location:
  • Phone: 415-939-6281
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number95008163
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95147064
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: