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General NPI Number Information
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NPI Number | 1780351072
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Entity Type | Individual
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Provider Name | RYAN SUNHO KIM NP-C
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Gender | Male
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Dates
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Enumeration Date | 08/25/2021
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Last Update Date | 06/01/2023
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Provider Practice Location Address
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Address Line | 4647 2ND ST STE 130
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City | DAVIS
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State | CA
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Zip | 95618-9428
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Country | US
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Telephone | 800-972-5547
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 255228
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City | SACRAMENTO
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State | CA
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Zip | 95865-5228
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Country | US
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Telephone |
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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 | 95018179
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License Number State | CA
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