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General NPI Number Information
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NPI Number | 1790480804
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Entity Type | Individual
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Provider Name | MELISSA KIM
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Gender | Female
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Dates
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Enumeration Date | 03/31/2023
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Last Update Date | 03/31/2023
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Provider Practice Location Address
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Address Line | 1035 W BEVERLY BLVD
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City | MONTEBELLO
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State | CA
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Zip | 90640-4138
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Country | US
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Telephone | 323-724-1315
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Fax |
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Provider Business Mailing Address
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Address Line | 345 S ALEXANDRIA AVE APT 220
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City | LOS ANGELES
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State | CA
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Zip | 90020-2670
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Country | US
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Telephone | 803-553-0576
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 24641
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License Number State | CA
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