MEDICARE: AIMEE KYUNGSUN 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
1	363LF0000X	Family Nurse Practitioner	NP95030300	CA

General Provider Information

NPI Number	:	1447093356
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AIMEE KYUNGSUN KIM

Provider Business Mailing Address
First Line	:	172 S COMMONWEALTH AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90004-6006
Country	:	US
Telephone Number	:	818-331-5536
Fax Number	:

Provider Business Practice Location Address
First Line	:	1911 W GLENOAKS BLVD STE B
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91201-4746
Country	:	US
Telephone Number	:	818-843-6640
Fax Number	:

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

Provider Enumeration Date	:	06/18/2024
Last Update Date	:	06/18/2024

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