Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XM0800X | Mental Health | 18692 | CA |
NPI | 1760951891 |
---|---|
Provider Name | Hee Kyung Kim |
First Address | South Pasadena, CA 91030-5725 |
Second Address | Los Angeles, CA 90035-2657 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/11/2018 |
Last Update Date | 19/11/2018 |