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General NPI Number Information
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NPI Number | 1598530263
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Entity Type | Individual
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Provider Name | JI AE JANICE KIM FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 11/22/2023
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Last Update Date | 11/22/2023
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Provider Practice Location Address
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Address Line | 966 S WESTERN AVE STE 101
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City | LOS ANGELES
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State | CA
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Zip | 90006-1014
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Country | US
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Telephone | 213-267-2256
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Fax |
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Provider Business Mailing Address
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Address Line | 7920 FAIR AVE
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City | SUN VALLEY
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State | CA
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Zip | 91352-4458
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Country | US
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Telephone | 818-579-5685
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 95027444
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License Number State | CA
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