Provider Demographics
NPI:1174345987
Name:SEAN, KIMBERLY ISHIHARA
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ISHIHARA
Last Name:SEAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3357 N CREST DR
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-4405
Mailing Address - Country:US
Mailing Address - Phone:714-310-4639
Mailing Address - Fax:
Practice Address - Street 1:4300 LONG BEACH BLVD STE 700
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-2000
Practice Address - Country:US
Practice Address - Phone:877-757-8353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-31
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA301700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist