Healthcare Provider Details

I. General information

NPI: 1578346656
Provider Name (Legal Business Name): JOSHUA KIM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2023
Last Update Date: 08/14/2023
Certification Date: 08/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12203 SANTA MONICA BLVD
LOS ANGELES CA
90025-2517
US

IV. Provider business mailing address

5832 SATURN ST UNIT 2
LOS ANGELES CA
90019-3741
US

V. Phone/Fax

Practice location:
  • Phone: 310-770-7586
  • Fax:
Mailing address:
  • Phone: 408-613-8513
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number304614
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: