Provider Demographics
NPI:1043635725
Name:KIM, ANNA
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:WON
Other - Middle Name:HO
Other - Last Name:CHUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1740 HUNTINGTON DR STE 305
Mailing Address - Street 2:
Mailing Address - City:DUARTE
Mailing Address - State:CA
Mailing Address - Zip Code:91010-3842
Mailing Address - Country:US
Mailing Address - Phone:626-531-6999
Mailing Address - Fax:
Practice Address - Street 1:1740 HUNTINGTON DR
Practice Address - Street 2:305
Practice Address - City:DUARTE
Practice Address - State:CA
Practice Address - Zip Code:91010-2580
Practice Address - Country:US
Practice Address - Phone:626-531-6999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-04
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11314193103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst