Provider Demographics
NPI:1073890968
Name:KIM, MARIA SANTOS
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:SANTOS
Last Name:KIM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 WILLOW PASS RD
Mailing Address - Street 2:200
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94520-5223
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1420 WILLOW PASS RD
Practice Address - Street 2:200
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-5223
Practice Address - Country:US
Practice Address - Phone:925-521-5115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-07
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health