Healthcare Provider Details

I. General information

NPI: 1447882592
Provider Name (Legal Business Name): KELLY BAEK KIM OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2020
Last Update Date: 01/02/2024
Certification Date: 01/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7320 FIRESTONE BLVD STE 105
DOWNEY CA
90241-4159
US

IV. Provider business mailing address

17042 BELLFLOWER BLVD
BELLFLOWER CA
90706-5950
US

V. Phone/Fax

Practice location:
  • Phone: 562-927-5820
  • Fax: 562-684-0102
Mailing address:
  • Phone: 562-991-1324
  • Fax: 562-684-0102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA5074
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number25909
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: