Healthcare Provider Details

I. General information

NPI: 1053528315
Provider Name (Legal Business Name): JIMMY P KIM DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 07/17/2025
Certification Date: 07/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N STATE ST
LOS ANGELES CA
90033-1029
US

IV. Provider business mailing address

2051 MARENGO ST
LOS ANGELES CA
90033-1352
US

V. Phone/Fax

Practice location:
  • Phone: 323-226-5096
  • Fax:
Mailing address:
  • Phone: 818-645-2833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number33691
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT 33691
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: