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General NPI Number Information
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NPI Number | 1275400731
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Entity Type | Individual
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Provider Name | DOO SOO KIM
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Gender | Male
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Dates
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Enumeration Date | 10/20/2025
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Last Update Date | 10/20/2025
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Provider Practice Location Address
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Address Line | 225 W RIDGECREST BLVD
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City | RIDGECREST
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State | CA
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Zip | 93555-4010
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Country | US
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Telephone | 310-307-0719
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Fax | 818-279-0658
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Provider Business Mailing Address
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Address Line | 9301 TAMPA AVE SPC 565
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City | NORTHRIDGE
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State | CA
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Zip | 91324-2503
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Country | US
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Telephone | 310-307-0719
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Fax | 818-279-0658
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 36971
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License Number State | CA
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