Provider Demographics
NPI:1073200895
Name:KIM, YOUNG MIN (CBT)
Entity Type:Individual
Prefix:
First Name:YOUNG MIN
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:CBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2310 130TH AVE NE STE 100
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-1757
Mailing Address - Country:US
Mailing Address - Phone:425-882-8868
Mailing Address - Fax:425-633-2282
Practice Address - Street 1:2310 130TH AVE NE STE 100
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-1757
Practice Address - Country:US
Practice Address - Phone:425-882-8868
Practice Address - Fax:425-633-2282
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-20
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61316751106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician