Provider Demographics
NPI:1215291372
Name:KIM, GILDA VIVIANA (MSCCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:GILDA
Middle Name:VIVIANA
Last Name:KIM
Suffix:
Gender:F
Credentials:MSCCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23011 CUERVO DR
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91354-2219
Mailing Address - Country:US
Mailing Address - Phone:661-644-5719
Mailing Address - Fax:661-513-0901
Practice Address - Street 1:23011 CUERVO DR
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91354-2219
Practice Address - Country:US
Practice Address - Phone:661-644-5719
Practice Address - Fax:661-513-0901
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-03
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9923235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist