Provider Demographics
NPI:1982001020
Name:KIM, SONIA YULIKA (BS)
Entity Type:Individual
Prefix:
First Name:SONIA
Middle Name:YULIKA
Last Name:KIM
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:SONIA
Other - Middle Name:YULIKA
Other - Last Name:LARGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS
Mailing Address - Street 1:2675 WINDMILL PKWY
Mailing Address - Street 2:APT 824
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-3394
Mailing Address - Country:US
Mailing Address - Phone:702-355-7234
Mailing Address - Fax:
Practice Address - Street 1:2675 WINDMILL PKWY
Practice Address - Street 2:APT 824
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-3394
Practice Address - Country:US
Practice Address - Phone:702-355-7234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-03
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner