Active NPI
Leila Broggi Kim, DPT
- Physical Therapist
- San Diego, CA
National Provider Identifier
1013122720
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT 30213
- Practice address
- 3666 Kearny Villa Rd
Suite 200
San Diego, CA 92123-1949 - Phone
- (858) 505-5400
- Fax
- (858) 505-5459
- NPI assigned
- May 14, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT 30213 | CA | Primary |
Addresses
Primary practice location
3666 Kearny Villa Rd
Suite 200
San Diego, CA 92123-1949
Mailing address
2707 Caminito Verdugo
Del Mar, CA 92014-3824
Phone (858) 792-7109
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT 30213 | CA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179100800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1013122720",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2707 CAMINITO VERDUGO",
"city": "DEL MAR",
"state": "CA",
"postal_code": "920143824",
"telephone_number": "858-792-7109"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3666 KEARNY VILLA RD",
"address_2": "SUITE 200",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921231949",
"telephone_number": "858-505-5400",
"fax_number": "858-505-5459"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "LEILA",
"middle_name": "BROGGI",
"name_prefix": "Mrs.",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-05-14",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "PT 30213",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.