Active NPI
Annie Grace Kim, MS, OTR/L
- Occupational Therapist
- Northridge, CA
National Provider Identifier
1336491836
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 12932
- Practice address
- 12121 Shadow Ridge Way
Northridge, CA 91326-3826 - Phone
- (818) 606-6902
- NPI assigned
- Oct 8, 2012
- Last updated
- Oct 8, 2012
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 12932 | CA | Primary |
Addresses
Primary practice location
12121 Shadow Ridge Way
Northridge, CA 91326-3826
Mailing address
12121 Shadow Ridge Way
Northridge, CA 91326-3826
Phone (818) 606-6902
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
- Credentials
- Master of Science
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1349654400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1349654400000",
"number": "1336491836",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12121 SHADOW RIDGE WAY",
"city": "NORTHRIDGE",
"state": "CA",
"postal_code": "913263826",
"telephone_number": "818-606-6902"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12121 SHADOW RIDGE WAY",
"city": "NORTHRIDGE",
"state": "CA",
"postal_code": "913263826",
"telephone_number": "818-606-6902"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "ANNIE",
"middle_name": "GRACE",
"credential": "MS, OTR/L",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-10-08",
"last_updated": "2012-10-08",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "CA",
"license": "12932",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Northridge, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.