Provider Demographics
NPI:1871527705
Name:KIM, JUNE L (ACNP)
Entity type:Individual
Prefix:
First Name:JUNE
Middle Name:L
Last Name:KIM
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18200 LORAIN AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44111-5605
Mailing Address - Country:US
Mailing Address - Phone:216-476-7606
Mailing Address - Fax:
Practice Address - Street 1:18200 LORAIN AVE # 430
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44111-5605
Practice Address - Country:US
Practice Address - Phone:216-476-7266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN-266928363L00000X
WVAPRN70101-ANP-BC363LA2200X
OH022935363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2507693Medicaid
WV3810013339Medicaid
OH209939OtherUNISON
OH000000503616OtherANTHEM
OH000000503616OtherANTHEM
Q14516Medicare UPIN
OH209939OtherUNISON
OHRENP15453Medicare PIN