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General NPI Number Information
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NPI Number | 1881083103
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Entity Type | Individual
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Provider Name | YOO JUNG KIM CRNA
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Gender | Female
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Dates
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Enumeration Date | 01/12/2015
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Last Update Date | 12/02/2021
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Provider Practice Location Address
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Address Line | 5323 HARRY HINES BLVD
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City | DALLAS
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State | TX
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Zip | 75390-7201
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Country | US
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Telephone | 214-648-3111
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Fax |
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Provider Business Mailing Address
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Address Line | 1825 THISTLE HILL DR APT 17101
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City | FORT WORTH
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State | TX
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Zip | 76110-7434
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Country | US
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Telephone | 817-239-3151
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 817179
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License Number State | TX
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