Provider Demographics
NPI:1003398686
Name:KIM, KATRINA HYUNSOOK (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:HYUNSOOK
Last Name:KIM
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25559 ORANGE CREST WAY
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-3733
Mailing Address - Country:US
Mailing Address - Phone:909-725-8977
Mailing Address - Fax:
Practice Address - Street 1:3989 W STETSON AVE STE 105
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92545-9697
Practice Address - Country:US
Practice Address - Phone:951-652-3334
Practice Address - Fax:951-652-3335
Is Sole Proprietor?:No
Enumeration Date:2018-08-30
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA295462225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist