Healthcare Provider Details

I. General information

NPI: 1235813528
Provider Name (Legal Business Name): JKIM NURSING, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2023
Last Update Date: 06/15/2023
Certification Date: 06/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3657 VAN BUREN BLVD
RIVERSIDE CA
92503-4249
US

IV. Provider business mailing address

9961 KAYLOR AVE
LOS ALAMITOS CA
90720-2225
US

V. Phone/Fax

Practice location:
  • Phone: 909-238-7966
  • Fax:
Mailing address:
  • Phone: 909-238-7966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOANNE KIM
Title or Position: CEO
Credential: N.P.
Phone: 909-238-7966