MEDICARE: MISS RACHEL KIM

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1356887368
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS RACHEL KIM

Provider Business Mailing Address
First Line	:	20909 NORWALK BLVD APT 10
Second Line	:
City	:	LAKEWOOD
State	:	CA
Zip	:	90715-1558
Country	:	US
Telephone Number	:	714-393-1318
Fax Number	:

Provider Business Practice Location Address
First Line	:	20909 NORWALK BLVD APT 10
Second Line	:
City	:	LAKEWOOD
State	:	CA
Zip	:	90715-1558
Country	:	US
Telephone Number	:	714-393-1318
Fax Number	:

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

Provider Enumeration Date	:	01/13/2017
Last Update Date	:	01/13/2017

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