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1760951891 NPI number — HEE KYUNG KIM OTD, OTR/L

NPI Number: 1760951891
Health Care Provider/Practitioner: HEE KYUNG KIM OTD, OTR/L

Information about “1760951891” NPI (HEE KYUNG KIM OTD, OTR/L) exists in 1760951891 in HTML format HTML  |  1760951891 in plain Text format TXT  |  1760951891 in PDF (Portable Document Format) PDF  |  1760951891 in an XML format XML  formats.

NPI Number : 1760951891 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1760951891",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "KIM",
    "FirstName": "HEE KYUNG",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "OTD, OTR/L",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "KIM",
    "OtherFirstName": "SADIE",
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "OTD, OTR/L",
    "OtherLastNameTypeCode": "5",
    "FirstLineMailingAddress": "1136 DIAMOND AVE APT A",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SOUTH PASADENA",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "91030-5725",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "818-331-5866",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "5980 W PICO BLVD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "LOS ANGELES",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "90035-2657",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "626-354-1584",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "11/19/2018",
    "LastUpdateDate": "11/19/2018",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "225XM0800X",
        "TaxonomyName": "Mental Health Occupational Therapist",
        "LicenseNumber": "18692",
        "LicenseNumberStateCode": "CA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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