Healthcare Provider Details

I. General information

NPI: 1861322273
Provider Name (Legal Business Name): MR. KI HYUN KIM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1841 W COMMONWEALTH AVE
FULLERTON CA
92833-3013
US

IV. Provider business mailing address

250 W CENTRAL AVE APT 309
BREA CA
92821-3365
US

V. Phone/Fax

Practice location:
  • Phone: 714-676-5828
  • Fax: 714-676-5829
Mailing address:
  • Phone: 714-356-5539
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number42703
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: