Provider Demographics
NPI:1356198139
Name:KIM, HEE SOOK (OT)
Entity type:Individual
Prefix:
First Name:HEE
Middle Name:SOOK
Last Name:KIM
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6035 EQUESTRIAN TER
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95677-4495
Mailing Address - Country:US
Mailing Address - Phone:503-706-2319
Mailing Address - Fax:
Practice Address - Street 1:6035 EQUESTRIAN TER
Practice Address - Street 2:
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95677-4495
Practice Address - Country:US
Practice Address - Phone:503-706-2319
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-01
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12279225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist