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General NPI Number Information
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NPI Number | 1457236689
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Entity Type | Individual
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Provider Name | MIRA KIM
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Gender | Female
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Dates
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Enumeration Date | 08/07/2025
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Last Update Date | 08/07/2025
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Provider Practice Location Address
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Address Line | 2888 LONG BEACH BLVD STE 340
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City | LONG BEACH
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State | CA
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Zip | 90806-1552
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Country | US
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Telephone | 562-933-0590
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Fax |
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Provider Business Mailing Address
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Address Line | 16358 CAMEO CT
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City | WHITTIER
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State | CA
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Zip | 90604-4031
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Country | US
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Telephone | 714-353-6339
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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 | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | 95034754
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License Number State | CA
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