Active NPI
Mi Kyong Kim
- Licensed Vocational Nurse
- Los Angeles, CA
National Provider Identifier
1760194484
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Vocational Nurse
- License
- 690473
- Practice address
- 2829 S Grand Ave
Los Angeles, CA 90007-3304 - Phone
- (213) 699-7041
- Fax
- (213) 765-0537
- NPI assigned
- Dec 14, 2022
- 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 |
|---|---|---|---|---|
| Licensed Vocational Nurse | 164X00000X | 690473 | CA | Primary |
Addresses
Primary practice location
2829 S Grand Ave
Los Angeles, CA 90007-3304
Mailing address
428 S Mariposa Ave Apt F
Los Angeles, CA 90020-2915
Phone (213) 700-6336
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 |
|---|---|---|---|
| 690473 | CA | MD | Licensed Vocational Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1670976000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1670976000000",
"number": "1760194484",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "428 S MARIPOSA AVE APT F",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900202915",
"telephone_number": "213-700-6336",
"fax_number": "213-765-0537"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2829 S GRAND AVE",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900073304",
"telephone_number": "213-699-7041",
"fax_number": "213-765-0537"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "MI KYONG",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-12-14",
"last_updated": "2022-12-14",
"certification_date": "2022-12-13",
"status": "A"
},
"taxonomies": [
{
"code": "164X00000X",
"taxonomy_group": "",
"desc": "Licensed Vocational Nurse",
"state": "CA",
"license": "690473",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.