MEDICARE: HYUNYOUNG KIM MS CCC-SLP

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	235Z00000X	Speech-Language Pathologist	SP14272	CA

General Provider Information

NPI Number	:	1821296831
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HYUNYOUNG KIM MS CCC-SLP

Provider Business Mailing Address
First Line	:	3545 WILSHIRE BLVD
Second Line	:	SUIT #250
City	:	LOS ANGELES
State	:	CA
Zip	:	90010-2354
Country	:	US
Telephone Number	:	310-270-6001
Fax Number	:

Provider Business Practice Location Address
First Line	:	3545 WILSHIRE BLVD
Second Line	:	SUIT #250
City	:	LOS ANGELES
State	:	CA
Zip	:	90010-2354
Country	:	US
Telephone Number	:	310-270-6001
Fax Number	:

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

Provider Enumeration Date	:	07/11/2007
Last Update Date	:	07/11/2007

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Directions to “ HYUNYOUNG KIM MS CCC-SLP” Practice Location

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