Healthcare Provider Details

I. General information

NPI: 1457273963
Provider Name (Legal Business Name): MONIQUE KIM-NOMURA
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 FASHION LN STE 224
TUSTIN CA
92780-3355
US

IV. Provider business mailing address

PO BOX 5362
BUENA PARK CA
90622-5362
US

V. Phone/Fax

Practice location:
  • Phone: 213-222-6553
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number140491
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: