Johnsam Kyle Bak

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

303375 Issued in CA

Practice address

1045 W Redondo Beach Blvd
Gardena, CA 90247-4128

Phone

(310) 329-1444

NPI assigned

Jan 10, 2023

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1673308800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1673308800000",
    "number": "1942914387",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2810 REDONDO BEACH BLVD",
            "city": "TORRANCE",
            "state": "CA",
            "postal_code": "905041531",
            "telephone_number": "310-995-6571"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1045 W REDONDO BEACH BLVD",
            "city": "GARDENA",
            "state": "CA",
            "postal_code": "902474128",
            "telephone_number": "310-329-1444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAK",
        "first_name": "JOHNSAM",
        "middle_name": "KYLE",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-01-10",
        "last_updated": "2023-01-10",
        "certification_date": "2023-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "303375",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Abel Zerai Bahta
• Anum Iqbal Baig, MD
• Emily Hana Bailey
• Sheila K Bailey
• Tennille Bailey
• Namasha Baker-Walls, NP
• Keturah Baker, MA, LMFT
• Stancia Baker
• Twaneisha Deauncey Baker
• Seema Bakshi

• Physical Therapist in Gardena, CA
• Providers in Gardena, CA by specialty
• Physical Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.