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NPI Code Detail

MEDICARE: GRACE KIM

MEDICARE: GRACE KIM
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225400000XRehabilitation PractitionerCA
2225C00000XRehabilitation CounselorCA
3103TC0700XClinical Psychologist26795CA

General Provider Information

NPI Number : 1669507851
Entity Type Code : Individual
Provider Name (Legal Business Name) : GRACE KIM
Provider Business Mailing Address
First Line : 447 N EL MOLINO AVE
Second Line :
City : PASADENA
State : CA
Zip : 91101-1403
Country : US
Telephone Number : 626-577-8480
Fax Number : 626-577-8978
Provider Business Practice Location Address
First Line : 3600 WILSHIRE BLVD STE 2200
Second Line :
City : LOS ANGELES
State : CA
Zip : 90010-2632
Country : US
Telephone Number : 213-382-4400
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/21/2007
Last Update Date : 02/27/2020

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Directions to “ GRACE KIM ” Practice Location

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