Provider Demographics
NPI:1740721430
Name:KIM, JUNHEE (CO)
Entity type:Individual
Prefix:MR
First Name:JUNHEE
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:CO
Other - Prefix:MR
Other - First Name:JUNHEE
Other - Middle Name:
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CO
Mailing Address - Street 1:1335 W VALENCIA DR STE M
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92833-4046
Mailing Address - Country:US
Mailing Address - Phone:714-726-3802
Mailing Address - Fax:714-464-4502
Practice Address - Street 1:1335 W VALENCIA DR STE M
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92833-4046
Practice Address - Country:US
Practice Address - Phone:714-726-3802
Practice Address - Fax:714-464-4502
Is Sole Proprietor?:No
Enumeration Date:2017-03-14
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC52354224P00000X, 222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist