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NPI Code Detail

MEDICARE: BO EUN KIM PA

MEDICARE: BO EUN KIM PA
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
1363A00000XPhysician Assistant

General Provider Information

NPI Number : 1326901414
Entity Type Code : Individual
Provider Name (Legal Business Name) : BO EUN KIM PA
Provider Business Mailing Address
First Line : 3974 PENNSYLVANIA AVE UNIT 102
Second Line :
City : GLENDALE
State : CA
Zip : 91214-3794
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3974 PENNSYLVANIA AVE
Second Line :
City : GLENDALE
State : CA
Zip : 91214-3793
Country : US
Telephone Number : 818-390-2324
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/05/2025
Last Update Date : 12/05/2025

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Directions to “ BO EUN KIM PA” Practice Location

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