MEDICARE: JI AE JANICE KIM FNP-BC

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	95027444	CA

General Provider Information

NPI Number	:	1598530263
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JI AE JANICE KIM FNP-BC

Provider Business Mailing Address
First Line	:	7920 FAIR AVE
Second Line	:
City	:	SUN VALLEY
State	:	CA
Zip	:	91352-4458
Country	:	US
Telephone Number	:	818-579-5685
Fax Number	:

Provider Business Practice Location Address
First Line	:	966 S WESTERN AVE STE 101
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90006-1014
Country	:	US
Telephone Number	:	213-267-2256
Fax Number	:

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

Provider Enumeration Date	:	11/22/2023
Last Update Date	:	11/22/2023

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