Healthcare Provider Details

I. General information

NPI: 1194125807
Provider Name (Legal Business Name): JUNG YUN KIM NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2014
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 N MAIN ST STE 220
SANTA ANA CA
92701-4623
US

IV. Provider business mailing address

520 N MAIN ST STE 220
SANTA ANA CA
92701-4623
US

V. Phone/Fax

Practice location:
  • Phone: 562-862-3684
  • Fax: 657-205-6066
Mailing address:
  • Phone: 562-862-3684
  • Fax: 657-205-6066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95001064
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number95001064
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: