Provider Demographics
NPI:1336622695
Name:KIM, ESTHER HYEUN (PA-C)
Entity type:Individual
Prefix:MS
First Name:ESTHER
Middle Name:HYEUN
Last Name:KIM
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 DOUGLAS BLVD STE 170
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-4281
Mailing Address - Country:US
Mailing Address - Phone:562-268-0955
Mailing Address - Fax:916-783-0513
Practice Address - Street 1:3400 DOUGLAS BLVD STE 170
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-4281
Practice Address - Country:US
Practice Address - Phone:562-268-0955
Practice Address - Fax:916-783-0513
Is Sole Proprietor?:No
Enumeration Date:2018-09-12
Last Update Date:2025-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56969363A00000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant