Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1013168624 |
---|---|
Provider Name | Hongsun Kim |
First Address | Los Angeles, CA 90015-1400 |
Second Address | Los Angeles, CA 90015-1400 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2008 |
Last Update Date | 02/10/2008 |