Provider Demographics
NPI:1013349349
Name:KIM, DAVID KEY YOUNG (OTR/L)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:KEY YOUNG
Last Name:KIM
Suffix:
Gender:M
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 1:8400 TUSCANY AVE APT 8
Mailing Address - Street 2:
Mailing Address - City:PLAYA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90293-7845
Mailing Address - Country:US
Mailing Address - Phone:510-703-8440
Mailing Address - Fax:
Practice Address - Street 1:8400 TUSCANY AVE APT 8
Practice Address - Street 2:
Practice Address - City:PLAYA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90293-7845
Practice Address - Country:US
Practice Address - Phone:510-703-8440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-09
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12739225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist