Provider Demographics
NPI:1326377292
Name:KIM SHIN, NAMJU (AGNP-C)
Entity type:Individual
Prefix:
First Name:NAMJU
Middle Name:
Last Name:KIM SHIN
Suffix:
Gender:F
Credentials:AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5471 LA PALMA AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:LA PALMA
Mailing Address - State:CA
Mailing Address - Zip Code:90623-1773
Mailing Address - Country:US
Mailing Address - Phone:714-695-2388
Mailing Address - Fax:714-695-2391
Practice Address - Street 1:5471 LA PALMA AVE STE 105
Practice Address - Street 2:
Practice Address - City:LA PALMA
Practice Address - State:CA
Practice Address - Zip Code:90623-1773
Practice Address - Country:US
Practice Address - Phone:714-695-2388
Practice Address - Fax:714-695-2391
Is Sole Proprietor?:No
Enumeration Date:2009-12-23
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18570363LA2200X, 363LA2100X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care