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General NPI Number Information
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NPI Number | 1578879862
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Entity Type | Individual
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Provider Name | EUN-CHONG KIM MPT
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Gender | Female
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Dates
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Enumeration Date | 08/24/2010
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Last Update Date | 08/24/2010
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Provider Practice Location Address
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Address Line | 2873 MUIR TRAIL DR
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City | FULLERTON
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State | CA
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Zip | 92833-5517
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Country | US
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Telephone | 562-690-8299
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Fax | 562-690-9746
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Provider Business Mailing Address
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Address Line | 2873 MUIR TRAIL DRIVE
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City | FULLERTON
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State | CA
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Zip | 92833
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Country | US
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Telephone | 562-690-8299
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Fax | 562-690-9746
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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 | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number | PT 25076
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License Number State | CA
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