Healthcare Provider Details

I. General information

NPI: 1275265696
Provider Name (Legal Business Name): HEE KIM FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2022
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3830 VALLEY CENTRE DR
SAN DIEGO CA
92130-3320
US

IV. Provider business mailing address

10605 SCRIPPS POWAY PKWY STE C
SAN DIEGO CA
92131-3925
US

V. Phone/Fax

Practice location:
  • Phone: 858-720-0554
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95021142
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: