Provider Demographics
NPI:1376589705
Name:KIM, ARMANDO (OTR/L)
Entity Type:Individual
Prefix:
First Name:ARMANDO
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:168 W WILLOW ST # 397
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91768-1828
Mailing Address - Country:US
Mailing Address - Phone:909-620-9700
Mailing Address - Fax:909-620-9800
Practice Address - Street 1:1902 ROYALTY DR
Practice Address - Street 2:STE 170
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-3030
Practice Address - Country:US
Practice Address - Phone:909-620-9700
Practice Address - Fax:909-620-9800
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5319225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand