Healthcare Provider Details

I. General information

NPI: 1831221217
Provider Name (Legal Business Name): MRS. KIM YOONG YONG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MRS. KIM YOONG PELAEZ

II. Dates (important events)

Enumeration Date: 03/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3544 ANZA ST
SAN FRANCISCO CA
94121-2927
US

IV. Provider business mailing address

3544 ANZA ST
SAN FRANCISCO CA
94121-2927
US

V. Phone/Fax

Practice location:
  • Phone: 415-752-0839
  • Fax:
Mailing address:
  • Phone: 415-752-0839
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number425471
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: