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General NPI Number Information
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NPI Number | 1790302453
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Entity Type | Individual
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Provider Name | ELNURA KIM
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Gender | Female
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Dates
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Enumeration Date | 06/29/2020
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Last Update Date | 06/29/2020
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Provider Practice Location Address
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Address Line | 13665 NEWCASTLE CT
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City | FONTANA
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State | CA
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Zip | 92335-0588
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Country | US
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Telephone | 626-394-9376
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Fax |
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Provider Business Mailing Address
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Address Line | 4560 SE INTERNATIONAL WAY STE 100
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City | MILWAUKIE
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State | OR
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Zip | 97222-4628
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Country | US
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Telephone |
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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 | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 5265
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License Number State | CA
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