Basic Information
| Provider Information | |||||||||
| NPI: | 1235727132 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | VONK | ||||||||
| FirstName: | KIM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5810 AMAYA DR APT 17D | ||||||||
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| City: | LA MESA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 919424140 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6193397368 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5905 SEVERIN DR. | ||||||||
| Address2: | |||||||||
| City: | LA MESA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 919423806 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6195892606 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/06/2021 | ||||||||
| LastUpdateDate: | 01/06/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/06/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225XH1200X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Hand |
No ID Information.