MEDICARE: JINHO 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	363LA2100X	Acute Care Nurse Practitioner	95023888	CA

General Provider Information

NPI Number	:	1770282402
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JINHO KIM

Provider Business Mailing Address
First Line	:	28404 VISTA DEL RIO DR
Second Line	:
City	:	VALENCIA
State	:	CA
Zip	:	91354-3080
Country	:	US
Telephone Number	:	931-551-6537
Fax Number	:

Provider Business Practice Location Address
First Line	:	1245 WILSHIRE BLVD STE 406
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90017-4804
Country	:	US
Telephone Number	:	213-372-5245
Fax Number	:

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

Provider Enumeration Date	:	03/02/2023
Last Update Date	:	12/30/2024

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Directions to “ JINHO KIM ” Practice Location

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