Individual
BLOSSOM KIM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
9108 TRUMBAUER WAY, ELK GROVE, CA 95758-7434
(916) 207-4257
Mailing address
9108 TRUMBAUER WAY, ELK GROVE, CA 95758-7434
(916) 207-4257
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
59082
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
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Other
Enumeration date
10/31/2019
Last updated
03/01/2021
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