Provider Demographics
NPI:1720525884
Name:KIM, LAURIANNE GUCE (PTA, BS)
Entity Type:Individual
Prefix:
First Name:LAURIANNE
Middle Name:GUCE
Last Name:KIM
Suffix:
Gender:F
Credentials:PTA, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8953 NE TENNYSON ST APT 218
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97006-2908
Mailing Address - Country:US
Mailing Address - Phone:714-504-6775
Mailing Address - Fax:
Practice Address - Street 1:8953 NE TENNYSON ST APT 218
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97006-2908
Practice Address - Country:US
Practice Address - Phone:714-504-6775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-27
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR09434225200000X
CA48166225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant