Healthcare Provider Details

I. General information

NPI: 1245146117
Provider Name (Legal Business Name): JUSTIN MINJOO KIM DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2935 MONTROSE AVE
LA CRESCENTA CA
91214-4401
US

IV. Provider business mailing address

2935 MONTROSE AVE APT 304
LA CRESCENTA CA
91214-4402
US

V. Phone/Fax

Practice location:
  • Phone: 818-808-3468
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number310482
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: