Provider Demographics
NPI:1437895299
Name:KIM, YOUNG RAE (DPT)
Entity Type:Individual
Prefix:
First Name:YOUNG
Middle Name:RAE
Last Name:KIM
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:12465 LEWIS ST STE 101
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92840-4658
Mailing Address - Country:US
Mailing Address - Phone:714-703-8477
Mailing Address - Fax:714-703-8157
Practice Address - Street 1:5832 BEACH BLVD STE 114
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90621-2010
Practice Address - Country:US
Practice Address - Phone:714-707-2699
Practice Address - Fax:714-784-2160
Is Sole Proprietor?:No
Enumeration Date:2022-05-05
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPT301938225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist