Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation |
NPI | 1003572637 |
---|---|
Provider Name | Yoseph Kim |
First Address | Wilsonville, OR 97070-9697 |
Second Address | Tacoma, WA 98407-2204 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2021 |
Last Update Date | 09/11/2021 |