Provider Demographics
NPI:1639335615
Name:KIM, MI OK (MSW)
Entity Type:Individual
Prefix:MRS
First Name:MI
Middle Name:OK
Last Name:KIM
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:17027 1/4 CLARK AVE
Mailing Address - Street 2:
Mailing Address - City:BELLFLOWER
Mailing Address - State:CA
Mailing Address - Zip Code:90706-5721
Mailing Address - Country:US
Mailing Address - Phone:562-659-2030
Mailing Address - Fax:562-867-3249
Practice Address - Street 1:17027 1/4 CLARK AVE
Practice Address - Street 2:
Practice Address - City:BELLFLOWER
Practice Address - State:CA
Practice Address - Zip Code:90706-5721
Practice Address - Country:US
Practice Address - Phone:562-659-2030
Practice Address - Fax:562-867-3249
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-30
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6121374Medicare Oscar/Certification