MEDICARE: MICHELLE JAY KIM NP

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	23796	CA

General Provider Information

NPI Number	:	1962839258
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE JAY KIM NP

Provider Business Mailing Address
First Line	:	4020 MONTAIGNE WAY
Second Line	:
City	:	PALOS VERDES PENINSULA
State	:	CA
Zip	:	90274-3940
Country	:	US
Telephone Number	:	310-710-5179
Fax Number	:

Provider Business Practice Location Address
First Line	:	4020 MONTAIGNE WAY
Second Line	:
City	:	PALOS VERDES PENINSULA
State	:	CA
Zip	:	90274-3940
Country	:	US
Telephone Number	:	310-710-5179
Fax Number	:

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

Provider Enumeration Date	:	10/01/2013
Last Update Date	:	10/01/2013

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