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General NPI Number Information
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NPI Number | 1255831285
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Entity Type | Organization
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Legal Business Name | JK PROREHAB INC
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Dates
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Enumeration Date | 02/16/2018
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Last Update Date | 02/16/2018
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Provider Practice Location Address
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Address Line | 18331 GRIDLEY RD STE CANDD
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City | CERRITOS
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State | CA
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Zip | 90703-5438
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Country | US
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Telephone | 562-317-4800
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Fax | 562-317-4801
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Provider Business Mailing Address
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Address Line | 18331 GRIDLEY RD STE C&D
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City | CERRITOS
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State | CA
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Zip | 90703-5438
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Country | US
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Telephone | 562-317-4800
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Fax | 562-317-4801
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Authorized Official
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Title or Position | PRESIDENT / PT
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Name | SUNG JIN KIM
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Credential | PT
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Telephone | 562-317-4800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 42303
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License Number State | CA
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