Healthcare Provider Details

I. General information

NPI: 1457025959
Provider Name (Legal Business Name): CHRISTINE PHUONG KIM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2021
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 LONG BEACH BLVD STE 700
LONG BEACH CA
90807-2000
US

IV. Provider business mailing address

8840 N MAGNOLIA AVE STE 220
SANTEE CA
92071-4516
US

V. Phone/Fax

Practice location:
  • Phone: 818-894-2273
  • Fax: 818-357-2505
Mailing address:
  • Phone: 619-749-7059
  • Fax: 619-749-7069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number32752
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: