Healthcare Provider Details

I. General information

NPI: 1497521355
Provider Name (Legal Business Name): JUSTIN KIM DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JONG HYEON KIM

II. Dates (important events)

Enumeration Date: 11/30/2023
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4585 N FIGUEROA ST
LOS ANGELES CA
90065-3026
US

IV. Provider business mailing address

1800 BEVERLY BLVD APT 439
LOS ANGELES CA
90057-5243
US

V. Phone/Fax

Practice location:
  • Phone: 323-223-3441
  • Fax:
Mailing address:
  • Phone: 469-274-3244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number305800
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: