Healthcare Provider Details

I. General information

NPI: 1700741469
Provider Name (Legal Business Name): EDUARDO KIM PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24318 HEMLOCK AVE STE A1
MORENO VALLEY CA
92557-7223
US

IV. Provider business mailing address

3230 E IMPERIAL HWY STE 100
BREA CA
92821-6735
US

V. Phone/Fax

Practice location:
  • Phone: 951-485-3800
  • Fax: 951-226-3684
Mailing address:
  • Phone: 714-256-5074
  • Fax: 714-256-0770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number309292
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: