Provider Demographics
NPI:1467916601
Name:KIM, JUHEE
Entity Type:Individual
Prefix:MISS
First Name:JUHEE
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1875 W REDONDO BEACH BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90247-3627
Mailing Address - Country:US
Mailing Address - Phone:310-715-1234
Mailing Address - Fax:310-715-5678
Practice Address - Street 1:1875 W REDONDO BEACH BLVD STE 100
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90247-3627
Practice Address - Country:US
Practice Address - Phone:310-715-1234
Practice Address - Fax:310-715-5678
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-22
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care