JUNG YOUN LEE KIM (NPI# 1093061491) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1093061491 |
| Entity Type | Individual |
| Full Name | JUNG YOUN LEE KIM |
| Practice Address |
614 Tully Rd San Jose CA 95111-1048 |
| Mailing Address |
3080 Mary Helen Ln San Jose CA 95136-4846 |
| Practice Telephone | 4084941575 |
| Mailing Telephone | 6502690763 |
| Enumeration Date | 2012-08-03 |
| Last Update Date | 2012-08-03 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 390200000X | Student in an Organized Health Care Education/Training Program | Student, Health Care |
| Street Address |
614 TULLY RD |
| City | SAN JOSE |
| State | CA |
| Zip Code | 95111-1048 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699843060 | Minh Chau Duong | Counselor | 614 Tully Rd, San Jose, CA 95111-1048 | 2006-12-01 |
| 1629630421 | Sonia Clemente | Counselor | 614 Tully Rd, San Jose, CA 95111-1048 | 2019-07-01 |
| 1376109629 | Gardner Family Health Network Inc | Community/Behavioral Health | 614 Tully Rd, San Jose, CA 95111-1048 | 2019-05-13 |
| 1316406481 | Ngoc Nguyen Hong Pham | Social Worker | 614 Tully Rd, San Jose, CA 95111-1048 | 2019-03-18 |
| 1386114437 | Eloisa Ivette Rodriguez | Social Worker | 614 Tully Rd, San Jose, CA 95111-1048 | 2018-12-03 |
| 1275016669 | Carolina Garcia | Rehabilitation Counselor | 614 Tully Rd, San Jose, CA 95111-1048 | 2018-09-11 |
| 1326572959 | Mar Joseph Odias | Registered Nurse | 614 Tully Rd, San Jose, CA 95111-1048 | 2017-04-20 |
| 1770021206 | Ryan Pagala | Registered Nurse | 614 Tully Rd, San Jose, CA 95111-1048 | 2017-02-03 |
| 1134667652 | Veronica Pham | Registered Nurse | 614 Tully Rd, San Jose, CA 95111-1048 | 2017-02-03 |
| 1952849481 | Michael Borromeo | Registered Nurse | 614 Tully Rd, San Jose, CA 95111-1048 | 2017-02-03 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134667413 | Aldo Hernandez | Community Health Worker | 488 Skyway Dr, San Jose, CA 95111 | 2017-02-07 |
| 1518217017 | Jean Jennifer J Soliven | Registered Nurse | 614 Tully Rd., San Jose, CA 95111 | 2012-09-12 |
| 1679894604 | Julie Chi | Counselor | 581 Coyote Road, San Jose, CA 95111 | 2010-06-14 |
| 1720278179 | Mv Transportation | Non-emergency Medical Transport (VAN) | 555 Tully Road, Mv Transportation, San Jose, CA 95111 | 2007-07-31 |
| 1437355948 | Anthony Cozzolino | Psychiatry & Neurology | 614 Tully Road, Narvaez Mental Health, San Jose, CA 95111 | 2007-06-22 |
| 1750403515 | Karen Pham | Dentist | 4074 Monterey Road, San Jose, CA 95111 | 2007-04-04 |
| 1376697847 | Mai Anh Le | Dentist | 60 Senter Rd, San Jose, CA 95111 | 2007-01-22 |
| 1649335852 | Bui and Enriquez Dental Corporation | Dentist | 485 Lewis Rd, Suite A, San Jose, CA 95111 | 2006-12-27 |
| 1619031903 | Huyen Thu Nguyen | Pharmacist | 796 Apple Terrace, San Jose, CA 95111 | 2006-12-20 |
| 1285720342 | Lily Khanh-linh Thi Nguyen | Obstetrics & Gynecology | 500 W Tully Rd, Ob/gyn Clinic, San Jose, CA 95111 | 2006-10-05 |
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| Taxonomy Code | 390200000X |
| Grouping | Student, Health Care |
| Classification | Student in an Organized Health Care Education/Training Program |
| An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |
| Notes: [1/1/2005: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215536206 | Marissa Burton | Student in an Organized Health Care Education/Training Program | 1759 Queenstown Dr, San Jose, CA 95132-1755 | 2020-10-21 |
| 1891394987 | Shannon Shen | Student in an Organized Health Care Education/Training Program | 190 Ryland St Apt 3422, San Jose, CA 95110-2295 | 2020-10-20 |
| 1750992152 | Jolene Thu Tran | Student in an Organized Health Care Education/Training Program | 2811 Glauser Dr, San Jose, CA 95133-1410 | 2020-08-11 |
| 1588273270 | Kimberly Ngoc Nguyen | Student in an Organized Health Care Education/Training Program | 3094 Seafield Ct, San Jose, CA 95148-4044 | 2020-07-28 |
| 1699393884 | Nancy Tang | Student in an Organized Health Care Education/Training Program | 3130 Brightwood Ct, San Jose, CA 95148-2649 | 2020-07-14 |
| 1548884125 | Chelsea Lorraine Barnes | Student in an Organized Health Care Education/Training Program | 1045 Lincoln Ct, San Jose, CA 95125-2638 | 2020-05-30 |
| 1891318705 | Magdalena Cachu-enciso | Student in an Organized Health Care Education/Training Program | 1624 June Ave, San Jose, CA 95122-2211 | 2020-05-26 |
| 1104448729 | Veerali Juthani | Student in an Organized Health Care Education/Training Program | 3920 Braeburn Ct, San Jose, CA 95130-1206 | 2020-05-18 |
| 1811518020 | Thomas Vo | Student in an Organized Health Care Education/Training Program | 3205 San Rivas Dr, San Jose, CA 95148-2037 | 2020-04-28 |
| 1831727130 | Brent Carmona | Student in an Organized Health Care Education/Training Program | 3791 Heppner Ln, San Jose, CA 95136-1506 | 2020-03-31 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.