Provider Demographics
NPI:1659097459
Name:KIM, HYUNJIB (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:HYUNJIB
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 PIER AVE STE B
Mailing Address - Street 2:
Mailing Address - City:HERMOSA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90254-3943
Mailing Address - Country:US
Mailing Address - Phone:310-598-6850
Mailing Address - Fax:310-424-4598
Practice Address - Street 1:2615 PACIFIC COAST HWY
Practice Address - Street 2:
Practice Address - City:HERMOSA BEACH
Practice Address - State:CA
Practice Address - Zip Code:90254-2225
Practice Address - Country:US
Practice Address - Phone:310-598-6850
Practice Address - Fax:310-424-4598
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-13
Last Update Date:2025-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95022903363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health