Provider Demographics
NPI:1588193759
Name:KIM, ELAINE JOY
Entity type:Individual
Prefix:MRS
First Name:ELAINE
Middle Name:JOY
Last Name:KIM
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:ELAINE
Other - Middle Name:JOY
Other - Last Name:INOUE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11100 MONTANA AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-3552
Mailing Address - Country:US
Mailing Address - Phone:310-963-6031
Mailing Address - Fax:
Practice Address - Street 1:5657 WILSHIRE BLVD STE 280
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90036-3755
Practice Address - Country:US
Practice Address - Phone:323-525-0247
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-09
Last Update Date:2017-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11511235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist