Provider Demographics
NPI:1225241748
Name:KIM, MONTHOR RENE (OTR)
Entity Type:Individual
Prefix:MS
First Name:MONTHOR
Middle Name:RENE
Last Name:KIM
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5199 E PACIFIC COAST HWY STE 610
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90804-3365
Mailing Address - Country:US
Mailing Address - Phone:562-961-5799
Mailing Address - Fax:562-961-5699
Practice Address - Street 1:5199 E PACIFIC COAST HWY STE 610
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804-3365
Practice Address - Country:US
Practice Address - Phone:562-961-5799
Practice Address - Fax:562-961-5699
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT 3772225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist