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General NPI Number Information
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NPI Number | 1811912629
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Entity Type | Organization
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Legal Business Name | ED KIM, INC.
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Dates
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Enumeration Date | 07/13/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3838 SHERMAN DR STE 11
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City | RIVERSIDE
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State | CA
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Zip | 92503-4001
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Country | US
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Telephone | 951-353-2831
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Fax | 951-353-2834
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Provider Business Mailing Address
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Address Line | 3838 SHERMAN DR STE 11
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City | RIVERSIDE
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State | CA
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Zip | 92503-4001
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Country | US
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Telephone | 951-353-2831
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Fax | 951-353-2834
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. ED KIM
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Credential | MPT
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Telephone | 951-353-2831
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT22700
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License Number State | CA
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