Provider Demographics
NPI:1386078327
Name:KIM, TERESA JIWON (NP)
Entity type:Individual
Prefix:MS
First Name:TERESA
Middle Name:JIWON
Last Name:KIM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11911 ARTESIA BLVD
Mailing Address - Street 2:STE#101
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90701-4065
Mailing Address - Country:US
Mailing Address - Phone:562-402-7622
Mailing Address - Fax:562-402-2452
Practice Address - Street 1:11911 ARTESIA BLVD
Practice Address - Street 2:STE#101
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90701-4065
Practice Address - Country:US
Practice Address - Phone:562-402-7622
Practice Address - Fax:562-402-2452
Is Sole Proprietor?:No
Enumeration Date:2013-08-27
Last Update Date:2014-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP22773363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily