MEDICARE: JOEL GILHOI KIM DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT43298	CA

General Provider Information

NPI Number	:	1255789764
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOEL GILHOI KIM DPT

Provider Business Mailing Address
First Line	:	930 W ALAMEDA AVE
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91506-2802
Country	:	US
Telephone Number	:	818-588-3880
Fax Number	:	866-593-6794

Provider Business Practice Location Address
First Line	:	930 W ALAMEDA AVE
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91506-2802
Country	:	US
Telephone Number	:	818-588-3880
Fax Number	:	866-593-6794

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/25/2016
Last Update Date	:	05/25/2016

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