Provider Demographics
NPI:1730711821
Name:KIM, HAEEUN (ASSOCIATE'S DEGREES)
Entity type:Individual
Prefix:
First Name:HAEEUN
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:ASSOCIATE'S DEGREES
Other - Prefix:
Other - First Name:HAEEUN
Other - Middle Name:
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:GRACE KIM
Mailing Address - Street 1:1008 LAS LOMAS DR UNIT C
Mailing Address - Street 2:
Mailing Address - City:LA HABRA
Mailing Address - State:CA
Mailing Address - Zip Code:90631-2263
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1008 LAS LOMAS DR UNIT C
Practice Address - Street 2:
Practice Address - City:LA HABRA
Practice Address - State:CA
Practice Address - Zip Code:90631-2263
Practice Address - Country:US
Practice Address - Phone:310-857-0827
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-07
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant