Organization
LAKESIDE PHYSICAL THERAPY, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FRED HYUNGSHIK KIM DPT (OWNER)
(949) 707-5442
Entity
Organization
Contact information
Practice address
27722 VISTA DEL LAGO, A1, MISSION VIEJO, CA 92692-1133
(949) 842-5735
Mailing address
23216 STELLA CT, LAKE FOREST, CA 92630-5336
(949) 707-5442
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
28555
CA
Other
Enumeration date
07/15/2009
Last updated
07/15/2009
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