Provider Demographics
NPI:1720214802
Name:KIM, ANNIE (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:ANNIE
Middle Name:
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 1:17572 EDGEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-1950
Mailing Address - Country:US
Mailing Address - Phone:714-837-8839
Mailing Address - Fax:714-524-0106
Practice Address - Street 1:17572 EDGEWOOD LN
Practice Address - Street 2:
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92886-1950
Practice Address - Country:US
Practice Address - Phone:714-837-8839
Practice Address - Fax:714-524-0106
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-03
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3605225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist