Healthcare Provider Details

I. General information

NPI: 1033046206
Provider Name (Legal Business Name): JENNIFER KIM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

86150 66TH AVE
THERMAL CA
92274-9626
US

IV. Provider business mailing address

13466 BEACH ST
CERRITOS CA
90703-1423
US

V. Phone/Fax

Practice location:
  • Phone: 760-397-2244
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: