MEDICARE: MR. KI HYUN 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
1	225700000X	Massage Therapist	42703	CA

General Provider Information

NPI Number	:	1861322273
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KI HYUN KIM

Provider Business Mailing Address
First Line	:	250 W CENTRAL AVE APT 309
Second Line	:
City	:	BREA
State	:	CA
Zip	:	92821-3365
Country	:	US
Telephone Number	:	714-356-5539
Fax Number	:

Provider Business Practice Location Address
First Line	:	1841 W COMMONWEALTH AVE
Second Line	:
City	:	FULLERTON
State	:	CA
Zip	:	92833-3013
Country	:	US
Telephone Number	:	714-676-5828
Fax Number	:	714-676-5829

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/20/2026
Last Update Date	:	05/20/2026

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