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General NPI Number Information
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NPI Number | 1346802543
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Entity Type | Individual
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Provider Name | JULIE KIM AHN PA-C
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Gender | Female
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Dates
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Enumeration Date | 07/08/2019
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Last Update Date | 07/08/2019
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Provider Practice Location Address
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Address Line | 800 S MAIN ST
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City | CORONA
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State | CA
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Zip | 92882-3420
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Country | US
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Telephone | 951-737-4343
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Fax |
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Provider Business Mailing Address
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Address Line | 435 GARFIELD AVE APT 105
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City | SOUTH PASADENA
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State | CA
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Zip | 91030-2238
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Country | US
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Telephone | 626-773-1296
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Fax |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 56992
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License Number State | CA
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