Provider Demographics
NPI:1316161508
Name:KURIHARA, KIM LOU (LPT)
Entity type:Individual
Prefix:MS
First Name:KIM
Middle Name:LOU
Last Name:KURIHARA
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:MS
Other - First Name:KIM
Other - Middle Name:LOU
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPT
Mailing Address - Street 1:15575 OLD WAGON ROAD
Mailing Address - Street 2:
Mailing Address - City:CRESCENT MILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95971
Mailing Address - Country:US
Mailing Address - Phone:530-284-7245
Mailing Address - Fax:
Practice Address - Street 1:410 MAIN STREET
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:CA
Practice Address - Zip Code:95947
Practice Address - Country:US
Practice Address - Phone:530-284-7990
Practice Address - Fax:530-284-6612
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 21949167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician