MEDICARE: JIEUN SIM

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	NP95008562	CA

General Provider Information

NPI Number	:	1932601952
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JIEUN SIM

Provider Business Mailing Address
First Line	:	11832 ROSECRANS AVE # 127
Second Line	:
City	:	NORWALK
State	:	CA
Zip	:	90650-4107
Country	:	US
Telephone Number	:	909-680-8683
Fax Number	:

Provider Business Practice Location Address
First Line	:	6714 BEACH BLVD
Second Line	:
City	:	BUENA PARK
State	:	CA
Zip	:	90621-3410
Country	:	US
Telephone Number	:	714-752-6778
Fax Number	:

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

Provider Enumeration Date	:	03/06/2018
Last Update Date	:	09/02/2020

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Directions to “ JIEUN SIM ” Practice Location

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