Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | OT 00002799 | WA |
N | 225XH1200X | Occupational Therapist - Hand | 2877 | CA |
NPI | 1003092149 |
---|---|
Provider Name | Ms. Hye Ryun Helen Kim |
First Address | Bolingbrook, IL 60440-4909 |
Second Address | Kent, WA 98030-2821 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/01/2008 |
Last Update Date | 13/07/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0291095 | DEPT. OF LABOR AND INDUSTRIES (01) | WA |