=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679498018
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DEBORAH KIM
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/13/2026
-----------------------------------------------------
Last Update Date | 08/13/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11050 LINDEN AVE
-----------------------------------------------------
City | BLOOMINGTON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92316-3118
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-580-5019
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 26149 PARK AVE UNIT 38
-----------------------------------------------------
City | LOMA LINDA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92354-6128
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-831-9049
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | 33747
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------