Provider Demographics
NPI:1083910434
Name:KIM, HEEYEON
Entity Type:Individual
Prefix:
First Name:HEEYEON
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:HEEYEON
Other - Middle Name:
Other - Last Name:UI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1001 S BROOKHURST RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92833-3700
Mailing Address - Country:US
Mailing Address - Phone:714-393-2990
Mailing Address - Fax:
Practice Address - Street 1:1001 S BROOKHURST RD
Practice Address - Street 2:SUITE 101
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92833-3700
Practice Address - Country:US
Practice Address - Phone:714-393-2990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-02
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist