Provider Demographics
NPI:1629006234
Name:KIM, LANCHI VU (MS)
Entity Type:Individual
Prefix:
First Name:LANCHI
Middle Name:VU
Last Name:KIM
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11360 183RD ST
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-5419
Mailing Address - Country:US
Mailing Address - Phone:562-809-2167
Mailing Address - Fax:562-809-8497
Practice Address - Street 1:11360 183RD ST
Practice Address - Street 2:
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-5419
Practice Address - Country:US
Practice Address - Phone:562-809-2167
Practice Address - Fax:562-809-8497
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU2433231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWAU2433AMedicare PIN