| Doctor Name: | MICHELLE JAY KIM |
| NPI Number: | 1962839258 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | NP |
| License Number: | 23796 |
| Business Practice Address: | 4020 Montaigne Way Palos Verdes Peninsula, CA - 902743940 |
| Business Phone Number: | 3107105179 |
| Business Fax Number: | |
| Mailing Address: | 4020 Montaigne Way, PALOS VERDES PENINSULA |
| State: | CA |
| Postal Code: | 902743940 |
| Phone Number: | 3107105179 |
| Fax Number: | |
| NPI Enumeration Date: | 10/01/2013 |
| NPI Last Update Date: | 10/01/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 23796 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |