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General NPI Number Information
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NPI Number | 1225426158
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Entity Type | Individual
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Provider Name | SUEUN KIM
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Gender | Female
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Dates
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Enumeration Date | 12/30/2014
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Last Update Date | 12/30/2014
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Provider Practice Location Address
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Address Line | 3551 W OLYMPIC BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90019-3504
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Country | US
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Telephone | 323-732-0350
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Fax |
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Provider Business Mailing Address
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Address Line | 532 CONCORD ST APT 106
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City | GLENDALE
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State | CA
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Zip | 91203-1578
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Country | US
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Telephone | 301-272-5759
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 19249
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License Number State | CA
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