Provider Demographics
NPI:1760951891
Name:KIM, HEE KYUNG (OTD, OTR/L)
Entity Type:Individual
Prefix:
First Name:HEE KYUNG
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:SADIE
Other - Middle Name:
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTD, OTR/L
Mailing Address - Street 1:1136 DIAMOND AVE APT A
Mailing Address - Street 2:
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91030-5725
Mailing Address - Country:US
Mailing Address - Phone:818-331-5866
Mailing Address - Fax:
Practice Address - Street 1:5980 W PICO BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035-2657
Practice Address - Country:US
Practice Address - Phone:626-354-1584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-19
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18692225XM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XM0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistMental Health