MEDICARE: GHIJUNG KIM I NP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AP136423	TX
2	363LA2200X	Adult Health Nurse Practitioner	AP136423	TX

General Provider Information

NPI Number	:	1023507100
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GHIJUNG KIM I NP-C

Provider Business Mailing Address
First Line	:	12221 N MOPAC EXPY
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78758-2401
Country	:	US
Telephone Number	:	737-600-2886
Fax Number	:	512-764-9417

Provider Business Practice Location Address
First Line	:	12221 N MOPAC EXPY
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78758-2401
Country	:	US
Telephone Number	:	512-901-1111
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2018
Last Update Date	:	12/20/2025

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