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General NPI Number Information
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NPI Number | 1346073939
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Entity Type | Individual
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Provider Name | MI JEONG KIM
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Gender | Female
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Dates
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Enumeration Date | 08/21/2024
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Last Update Date | 05/31/2025
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Provider Practice Location Address
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Address Line | 1250 W WASHINGTON ST STE 215
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City | TEMPE
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State | AZ
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Zip | 85288-1697
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Country | US
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Telephone | 928-272-7224
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Fax | 480-956-0829
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Provider Business Mailing Address
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Address Line | 4539 N 22ND ST STE B
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City | PHOENIX
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State | AZ
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Zip | 85016-4639
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Country | US
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Telephone | 520-499-0778
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Fax | 480-956-0829
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 313108
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License Number State | AZ
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