Healthcare Provider Details

I. General information

NPI: 1215831938
Provider Name (Legal Business Name): BOKYUNG KIM NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36101 BOB HOPE DR STE A
RANCHO MIRAGE CA
92270-2001
US

IV. Provider business mailing address

35142 VIDALIA LN
BEAUMONT CA
92223-6297
US

V. Phone/Fax

Practice location:
  • Phone: 760-321-1315
  • Fax:
Mailing address:
  • Phone: 909-654-2076
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95037951
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: