Active NPI
Kwon Soon Yoo Kim, NURSE PRACTIONER
- Nurse Practitioner
- San Gabriel, CA
National Provider Identifier
1720103427
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- NP13939
- Practice address
- 1840 S. San Gabriel Blvd,
San Gabriel, CA 91776-3930 - Phone
- (626) 571-4590
- Fax
- (626) 307-7369
- NPI assigned
- Mar 20, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | NP13939 | CA | Primary |
Addresses
Primary practice location
1840 S. San Gabriel Blvd,
San Gabriel, CA 91776-3930
Mailing address
519 S. Topside PL.
Diamond Bar, CA 91765-1879
Phone (626) 571-4590
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| NP13939 | CA | MD | Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174348800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1720103427",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "519 S. TOPSIDE PL.",
"city": "DIAMOND BAR",
"state": "CA",
"postal_code": "917651879",
"telephone_number": "626-571-4590",
"fax_number": "626-307-7369"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1840 S. SAN GABRIEL BLVD,",
"city": "SAN GABRIEL",
"state": "CA",
"postal_code": "917763930",
"telephone_number": "626-571-4590",
"fax_number": "626-307-7369"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "KWON SOON",
"middle_name": "YOO",
"name_prefix": "Mrs.",
"credential": "NURSE PRACTIONER",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-03-20",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "CA",
"license": "NP13939",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Gabriel, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.