Provider Demographics
NPI:1174890156
Name:KIM, JUNG HEE
Entity type:Individual
Prefix:
First Name:JUNG HEE
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41-905 HANYANG APT.APGUJEONG-DONG.GANGNAM-GU
Mailing Address - Street 2:
Mailing Address - City:SEOUL
Mailing Address - State:SEOUL
Mailing Address - Zip Code:135
Mailing Address - Country:KR
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:FHP-PREVENTIVE MEDICINE, OHS
Practice Address - Street 2:UNIT #15281
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96205-5281
Practice Address - Country:US
Practice Address - Phone:315-736-8513
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-19
Last Update Date:2011-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA540340163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse