Provider Demographics
NPI:1063667863
Name:THORNBURGH, CHU KIM (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CHU
Middle Name:KIM
Last Name:THORNBURGH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 WILSHIRE BLVD
Mailing Address - Street 2:SUITE #500
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-4303
Mailing Address - Country:US
Mailing Address - Phone:213-639-0251
Mailing Address - Fax:213-388-2813
Practice Address - Street 1:2500 WILSHIRE BLVD
Practice Address - Street 2:SUITE #500
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-4303
Practice Address - Country:US
Practice Address - Phone:213-639-0251
Practice Address - Fax:213-388-2813
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-20
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 194731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical