Provider Demographics
NPI:1013122720
Name:KIM, LEILA BROGGI (DPT)
Entity Type:Individual
Prefix:MRS
First Name:LEILA
Middle Name:BROGGI
Last Name:KIM
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2707 CAMINITO VERDUGO
Mailing Address - Street 2:
Mailing Address - City:DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92014-3824
Mailing Address - Country:US
Mailing Address - Phone:858-792-7109
Mailing Address - Fax:
Practice Address - Street 1:3666 KEARNY VILLA RD
Practice Address - Street 2:SUITE 200
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1949
Practice Address - Country:US
Practice Address - Phone:858-505-5400
Practice Address - Fax:858-505-5459
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 30213225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist