Provider Demographics
NPI:1558759241
Name:KIM, CAROLINE SOHJUNG (OTR/L)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:SOHJUNG
Last Name:KIM
Suffix:
Gender:F
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 1:4660 ENCINAS DR
Mailing Address - Street 2:
Mailing Address - City:LA CANADA
Mailing Address - State:CA
Mailing Address - Zip Code:91011-2227
Mailing Address - Country:US
Mailing Address - Phone:818-454-9597
Mailing Address - Fax:
Practice Address - Street 1:4660 ENCINAS DR
Practice Address - Street 2:
Practice Address - City:LA CANADA
Practice Address - State:CA
Practice Address - Zip Code:91011-2227
Practice Address - Country:US
Practice Address - Phone:818-454-9597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-02
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17051225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist