Healthcare Provider Details

I. General information

NPI: 1699357855
Provider Name (Legal Business Name): KARIS KIM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2021
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15000 WHIRLAWAY LN
CHINO HILLS CA
91709-2548
US

IV. Provider business mailing address

13461 RAMONA AVE
CHINO CA
91710-5029
US

V. Phone/Fax

Practice location:
  • Phone: 909-393-4087
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: