Healthcare Provider Details

I. General information

NPI: 1679498018
Provider Name (Legal Business Name): DEBORAH KIM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DEBORAH CHO

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11050 LINDEN AVE
BLOOMINGTON CA
92316-3118
US

IV. Provider business mailing address

26149 PARK AVE UNIT 38
LOMA LINDA CA
92354-6128
US

V. Phone/Fax

Practice location:
  • Phone: 909-580-5019
  • Fax:
Mailing address:
  • Phone: 909-831-9049
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number33747
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: