Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) |
NPI | 1003405846 |
---|---|
Provider Name | Ken Sangboem Kim |
First Address | Irvine, CA 92623-7393 |
Second Address | Orange, CA 92868-3355 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/01/2021 |
Last Update Date | 15/01/2021 |