Provider Demographics
NPI:1326265075
Name:KIM, JEMMA E (PT)
Entity Type:Individual
Prefix:
First Name:JEMMA
Middle Name:E
Last Name:KIM
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:426 SALISBURY LN
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-1936
Mailing Address - Country:US
Mailing Address - Phone:909-482-0406
Mailing Address - Fax:909-482-0406
Practice Address - Street 1:3699 WILSHIRE BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-2719
Practice Address - Country:US
Practice Address - Phone:323-783-4375
Practice Address - Fax:323-783-7460
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 18969225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist