Provider Demographics
NPI:1801291877
Name:KIM, JESSINDA
Entity type:Individual
Prefix:
First Name:JESSINDA
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 SOUTH CRENSHAW BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90016
Mailing Address - Country:US
Mailing Address - Phone:323-293-6284
Mailing Address - Fax:323-295-4075
Practice Address - Street 1:1900 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-5502
Practice Address - Country:US
Practice Address - Phone:562-218-9530
Practice Address - Fax:562-200-9616
Is Sole Proprietor?:No
Enumeration Date:2014-11-03
Last Update Date:2014-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker