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General NPI Number Information
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NPI Number | 1770282402
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Entity Type | Individual
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Provider Name | JINHO KIM
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Gender | Male
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Dates
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Enumeration Date | 03/02/2023
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Last Update Date | 12/30/2024
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Provider Practice Location Address
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Address Line | 1245 WILSHIRE BLVD STE 406
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City | LOS ANGELES
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State | CA
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Zip | 90017-4804
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Country | US
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Telephone | 213-372-5245
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Fax |
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Provider Business Mailing Address
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Address Line | 28404 VISTA DEL RIO DR
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City | VALENCIA
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State | CA
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Zip | 91354-3080
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Country | US
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Telephone | 931-551-6537
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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 | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 95023888
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License Number State | CA
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