Healthcare Provider Details

I. General information

NPI: 1467166942
Provider Name (Legal Business Name): YUNMI KIM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2023
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10737 CAMINO RUIZ
SAN DIEGO CA
92126-2359
US

IV. Provider business mailing address

637 3RD AVE STE E1
CHULA VISTA CA
91910-5707
US

V. Phone/Fax

Practice location:
  • Phone: 844-200-2426
  • Fax: 619-474-4008
Mailing address:
  • Phone: 844-200-2426
  • Fax: 619-356-2726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number95023829
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: