Healthcare Provider Details

I. General information

NPI: 1972445609
Provider Name (Legal Business Name): ANIKA YURI KIM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2026
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1975 ZONAL AVE
LOS ANGELES CA
90089-5601
US

IV. Provider business mailing address

1013 EVERETT ST APT 216
LOS ANGELES CA
90026-7500
US

V. Phone/Fax

Practice location:
  • Phone: 323-442-7903
  • Fax:
Mailing address:
  • Phone: 215-470-6201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: