Provider Demographics
NPI:1124280987
Name:KIM, SUE (RNFA)
Entity type:Individual
Prefix:
First Name:SUE
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9201 W SUNSET BLVD STE 404
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90069-3705
Mailing Address - Country:US
Mailing Address - Phone:310-266-8921
Mailing Address - Fax:310-775-9762
Practice Address - Street 1:9201 W SUNSET BLVD STE 404
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90069-3705
Practice Address - Country:US
Practice Address - Phone:310-266-8921
Practice Address - Fax:310-775-9762
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-01
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CARN493968363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical