Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor |
NPI | 1003331802 |
---|---|
Provider Name | Timothy Kim |
First Address | San Francisco, CA 94118-3502 |
Second Address | San Francisco, CA 94121-2604 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2017 |
Last Update Date | 14/09/2021 |