Healthcare Provider Details

I. General information

NPI: 1962258970
Provider Name (Legal Business Name): BORAM KIM PHD, APRN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2024
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20911 EARL ST STE 440
TORRANCE CA
90503-4355
US

IV. Provider business mailing address

20911 EARL ST STE 440
TORRANCE CA
90503-4355
US

V. Phone/Fax

Practice location:
  • Phone: 310-793-2566
  • Fax: 310-419-8553
Mailing address:
  • Phone: 310-793-2566
  • Fax: 310-419-8553

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95029543
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: