Healthcare Provider Details

I. General information

NPI: 1497143127
Provider Name (Legal Business Name): SIMPLETHERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2015
Last Update Date: 06/22/2023
Certification Date: 06/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1080 W SHAW AVE STE 105
FRESNO CA
93711-3722
US

IV. Provider business mailing address

1080 W SHAW AVE STE 105
FRESNO CA
93711-3722
US

V. Phone/Fax

Practice location:
  • Phone: 800-644-2478
  • Fax:
Mailing address:
  • Phone: 800-644-2478
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name: DR. TAE WON KIM
Title or Position: CMO
Credential: MD
Phone: 215-516-9660