Individual
MRS. JENNELL M KIM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
9764 GARDEN GROVE BLVD, GARDEN GROVE, CA 92844-1615
(714) 349-3491
(714) 670-0005
Mailing address
9764 GARDEN GROVE BLVD, GARDEN GROVE, CA 92844-1615
(714) 349-3491
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT14698
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OT14698
CALIFORNIA BOARD OF OCCUPATIONAL THERAPY
CA
Enumeration date
10/28/2016
Last updated
10/28/2016
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