Provider Demographics
NPI:1881086429
Name:KIM, ELENA V (LMP)
Entity type:Individual
Prefix:MRS
First Name:ELENA
Middle Name:V
Last Name:KIM
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25011 18TH AVE S
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:WA
Mailing Address - Zip Code:98198-8567
Mailing Address - Country:US
Mailing Address - Phone:206-290-3896
Mailing Address - Fax:
Practice Address - Street 1:124 4TH AVE S
Practice Address - Street 2:#250
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-5874
Practice Address - Country:US
Practice Address - Phone:206-734-3281
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-19
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60539026225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist