Healthcare Provider Details

I. General information

NPI: 1871178111
Provider Name (Legal Business Name): SUNNY KIM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2021
Last Update Date: 01/03/2025
Certification Date: 01/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4772 KATELLA AVE STE 100
LOS ALAMITOS CA
90720-2681
US

IV. Provider business mailing address

13509 3/4 VILLAGE DR
CERRITOS CA
90703-2359
US

V. Phone/Fax

Practice location:
  • Phone: 562-430-8700
  • Fax:
Mailing address:
  • Phone: 562-714-2419
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number26844
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: