Provider Demographics
NPI:1699437756
Name:KIM, LISA AHN (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:AHN
Last Name:KIM
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27076 CYPRESS ST
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:CA
Mailing Address - Zip Code:92346-3662
Mailing Address - Country:US
Mailing Address - Phone:951-223-5354
Mailing Address - Fax:
Practice Address - Street 1:3060 W OLYMPIC BLVD APT 649
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-3844
Practice Address - Country:US
Practice Address - Phone:818-648-7127
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-06
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist