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NPI Code Detail

MEDICARE: MIN KIM NP

MEDICARE: MIN KIM NP
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
1363LP0808XPsychiatric/Mental Health Nurse Practitioner95017412CA
2363LF0000XFamily Nurse Practitioner95017412CA

General Provider Information

NPI Number : 1053088849
Entity Type Code : Individual
Provider Name (Legal Business Name) : MIN KIM NP
Provider Business Mailing Address
First Line : 8944 RATHBURN AVE
Second Line :
City : NORTHRIDGE
State : CA
Zip : 91325-2749
Country : US
Telephone Number : 213-842-6268
Fax Number :
Provider Business Practice Location Address
First Line : 43322 GINGHAM AVE
Second Line :
City : LANCASTER
State : CA
Zip : 93535-4576
Country : US
Telephone Number : 661-874-4050
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/27/2021
Last Update Date : 05/07/2026

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