Provider Demographics
NPI:1679308159
Name:KIM, CHRISTOPHER (PT, DPT)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6801 ELMHURST CT
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-6706
Mailing Address - Country:US
Mailing Address - Phone:562-818-0602
Mailing Address - Fax:
Practice Address - Street 1:23655 VIA DEL RIO STE C
Practice Address - Street 2:
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92887-2718
Practice Address - Country:US
Practice Address - Phone:714-695-1566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-04
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA306741225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist