Provider Demographics
NPI:1639052814
Name:GIM, NATHANIEL
Entity type:Individual
Prefix:MR
First Name:NATHANIEL
Middle Name:
Last Name:GIM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2675 DONEGAL AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94080-5311
Mailing Address - Country:US
Mailing Address - Phone:650-766-6372
Mailing Address - Fax:
Practice Address - Street 1:931 SAN BRUNO AVE W STE 1&2
Practice Address - Street 2:
Practice Address - City:SAN BRUNO
Practice Address - State:CA
Practice Address - Zip Code:94066-3440
Practice Address - Country:US
Practice Address - Phone:650-517-8220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-28
Last Update Date:2025-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist
No172V00000XOther Service ProvidersCommunity Health Worker