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NPI Code Detail

MEDICARE: KEVIN KIM DPT

MEDICARE: KEVIN KIM DPT
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
1225100000XPhysical TherapistPT291906CA

General Provider Information

NPI Number : 1861930646
Entity Type Code : Individual
Provider Name (Legal Business Name) : KEVIN KIM DPT
Provider Business Mailing Address
First Line : 4115 SOUTH ST
Second Line :
City : LAKEWOOD
State : CA
Zip : 90712-1043
Country : US
Telephone Number : 562-408-1140
Fax Number : 562-408-1141
Provider Business Practice Location Address
First Line : 4115 SOUTH ST
Second Line :
City : LAKEWOOD
State : CA
Zip : 90712-1043
Country : US
Telephone Number : 562-408-1140
Fax Number : 562-408-1141
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/01/2017
Last Update Date : 07/17/2022

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