Active NPI
Tina Kim, OTR/L
- Occupational Therapist
- Murrieta, CA
National Provider Identifier
1689965154
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 13805
- Practice address
- 29995 Technology Dr
Suite 103
Murrieta, CA 92563-2632 - Phone
- (951) 304-1100
- NPI assigned
- May 2, 2011
- 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 |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 13805 | CA | Primary |
Addresses
Primary practice location
29995 Technology Dr
Suite 103
Murrieta, CA 92563-2632
Mailing address
40680 California Oaks Rd
Ste 2a
Murrieta, CA 92562-5755
Phone (951) 894-4800
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13805 | CA | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1304294400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1469404800000",
"number": "1689965154",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "40680 CALIFORNIA OAKS RD",
"address_2": "STE 2A",
"city": "MURRIETA",
"state": "CA",
"postal_code": "925625755",
"telephone_number": "951-894-4800",
"fax_number": "951-894-4804"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "29995 TECHNOLOGY DR",
"address_2": "SUITE 103",
"city": "MURRIETA",
"state": "CA",
"postal_code": "925632632",
"telephone_number": "951-304-1100"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "TINA",
"credential": "OTR/L",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-05-02",
"last_updated": "2016-07-25",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "CA",
"license": "13805",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Murrieta, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.