Provider Demographics
NPI:1699834101
Name:ASAHARA, KYM KN (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KYM
Middle Name:KN
Last Name:ASAHARA
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 W PROVIDENCE AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-3808
Mailing Address - Country:US
Mailing Address - Phone:714-639-4990
Mailing Address - Fax:714-744-3841
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:2006-12-08
Last Update Date:2019-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP10361235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist