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General NPI Number Information
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NPI Number | 1699437756
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Entity Type | Individual
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Provider Name | LISA AHN KIM M.S., CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 10/06/2021
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Last Update Date | 05/23/2023
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Provider Practice Location Address
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Address Line | 3060 W OLYMPIC BLVD APT 649
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City | LOS ANGELES
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State | CA
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Zip | 90006-3844
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Country | US
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Telephone | 818-648-7127
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Fax |
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Provider Business Mailing Address
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Address Line | 27076 CYPRESS ST
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City | HIGHLAND
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State | CA
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Zip | 92346-3662
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Country | US
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Telephone | 951-223-5354
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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 |
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License Number State |
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