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General NPI Number Information
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NPI Number | 1760194484
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Entity Type | Individual
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Provider Name | MI KYONG KIM
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Gender | Female
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Dates
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Enumeration Date | 12/14/2022
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Last Update Date | 12/14/2022
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Provider Practice Location Address
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Address Line | 2829 S GRAND AVE
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City | LOS ANGELES
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State | CA
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Zip | 90007-3304
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Country | US
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Telephone | 213-699-7041
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Fax | 213-765-0537
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Provider Business Mailing Address
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Address Line | 428 S MARIPOSA AVE APT F
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City | LOS ANGELES
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State | CA
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Zip | 90020-2915
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Country | US
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Telephone | 213-700-6336
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Fax | 213-765-0537
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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 | 164X00000X
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Taxonomy Name | Licensed Vocational Nurse
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License Number | 690473
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License Number State | CA
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