Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TA0700X | Adult Development & Aging Psychologist | ||
N | 103G00000X | Clinical Psychologist | 17994 | CA |
N | 103TC0700X | Clinical Psychologist | 17994 | CA |
N | 103TH0100X | Health Service |
NPI | 1063410397 |
---|---|
Provider Name | Dr. Jung Yun Kim |
First Address | Los Angeles, CA 90048-5354 |
Second Address | Los Angeles, CA 90010-2307 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2005 |
Last Update Date | 08/07/2007 |