Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 25300 | CA |
NPI | 1003055898 |
---|---|
Provider Name | Cortland Robert Kim |
First Address | San Francisco, CA 94118-3314 |
Second Address | San Francisco, CA 94118-3314 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/02/2009 |
Last Update Date | 18/02/2009 |