Healthcare Provider Details

I. General information

NPI: 1841089950
Provider Name (Legal Business Name): CARRIE KIM IBCLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2025
Last Update Date: 05/05/2025
Certification Date: 04/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 VALLEJO WAY
SACRAMENTO CA
95818-3847
US

IV. Provider business mailing address

166 GEARY ST. STE 1500 #2793
SAN FRANCISCO CA
94108
US

V. Phone/Fax

Practice location:
  • Phone: 209-559-8681
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: CARRIE KIM
Title or Position: OWNER
Credential: IBCLC
Phone: 209-559-8681