Provider Demographics
NPI:1144945189
Name:KIM, BENNETH BUNDIT (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:BENNETH
Middle Name:BUNDIT
Last Name:KIM
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20516 EARL ST
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-3007
Mailing Address - Country:US
Mailing Address - Phone:310-808-7612
Mailing Address - Fax:
Practice Address - Street 1:4200 CHINO HILLS PKWY STE 825
Practice Address - Street 2:
Practice Address - City:CHINO HILLS
Practice Address - State:CA
Practice Address - Zip Code:91709-5832
Practice Address - Country:US
Practice Address - Phone:310-808-7612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-11
Last Update Date:2025-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA302944225100000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist