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NPI Code Detail

MEDICARE: MICHELLE KIM

MEDICARE: MICHELLE KIM
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
1363LF0000XFamily Nurse Practitioner95001135CA

General Provider Information

NPI Number : 1033589783
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHELLE KIM
Provider Business Mailing Address
First Line : 1420 S FIGUEROA ST APT 302
Second Line :
City : LOS ANGELES
State : CA
Zip : 90015-3295
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 6430 SELMA AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90028-7311
Country : US
Telephone Number : 323-848-4522
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/06/2015
Last Update Date : 10/06/2015

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Directions to “ MICHELLE KIM ” Practice Location

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