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General NPI Number Information
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NPI Number | 1720519283
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Entity Type | Individual
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Provider Name | JAE YOUN KIM FNP-C
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Gender | Female
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Dates
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Enumeration Date | 03/25/2017
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Last Update Date | 12/02/2025
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Provider Practice Location Address
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Address Line | 1375 BLOSSOM HILL RD STE 49
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City | SAN JOSE
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State | CA
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Zip | 95118-3806
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Country | US
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Telephone | 408-645-7073
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Fax | 669-500-7491
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Provider Business Mailing Address
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Address Line | 1375 BLOSSOM HILL RD STE 49
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City | SAN JOSE
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State | CA
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Zip | 95118-3806
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Country | US
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Telephone | 408-645-7073
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Fax | 669-500-7491
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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 | RN213977
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 95034282
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License Number State | CA
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