Healthcare Provider Details

I. General information

NPI: 1306527924
Provider Name (Legal Business Name): JUDY S KIM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2023
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1411 W 190TH ST STE 110
GARDENA CA
90248-4370
US

IV. Provider business mailing address

1411 W 190TH ST STE 110
GARDENA CA
90248-4370
US

V. Phone/Fax

Practice location:
  • Phone: 714-834-1111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number999016
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: