Healthcare Provider Details

I. General information

NPI: 1891371902
Provider Name (Legal Business Name): JOANNE YOO KIM PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JOANNE YOO

II. Dates (important events)

Enumeration Date: 03/19/2021
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26732 CROWN VALLEY PKWY STE 381
MISSION VIEJO CA
92691-7303
US

IV. Provider business mailing address

26732 CROWN VALLEY PKWY STE 381
MISSION VIEJO CA
92691-7303
US

V. Phone/Fax

Practice location:
  • Phone: 949-364-4400
  • Fax: 949-364-2829
Mailing address:
  • Phone: 949-364-4400
  • Fax: 949-364-2829

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number59213
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: