Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | 20529 | CA |
Y | 225XH1200X | Occupational Therapist - Hand | 20529 | CA |
NPI | 1205449642 |
---|---|
Provider Name | Sarah Kim |
First Address | Los Angeles, CA 90036-4130 |
Second Address | Santa Monica, CA 90403-5683 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/08/2020 |
Last Update Date | 25/08/2020 |