Provider Demographics
NPI:1124822838
Name:KIM, SEAN JUNG-AHN (PT, DPT)
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:JUNG-AHN
Last Name:KIM
Suffix:
Gender:
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 1:5341 TEMPLETON ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90032-2347
Mailing Address - Country:US
Mailing Address - Phone:440-785-8551
Mailing Address - Fax:
Practice Address - Street 1:2555 E COLORADO BLVD STE 204
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-6636
Practice Address - Country:US
Practice Address - Phone:626-449-9910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-02
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA307641225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist