| Doctor Name: | GINA KIM |
| NPI Number: | 1255786422 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 10557 |
| Business Practice Address: | 23361 Madero Ste #150 Mission Viejo, CA - 926912715 |
| Business Phone Number: | 9495818239 |
| Business Fax Number: | |
| Mailing Address: | 21141 Canada Rd, Apt 2a LAKE FOREST |
| State: | CA |
| Postal Code: | 926302754 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 04/25/2016 |
| NPI Last Update Date: | 04/25/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | 10557 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Speech-Language Pathologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A speech pathologist is a person qualified by a master |