Provider Demographics
NPI:1073919866
Name:KIM, CLOE TAEHEE (LCSW, MSW)
Entity Type:Individual
Prefix:
First Name:CLOE
Middle Name:TAEHEE
Last Name:KIM
Suffix:
Gender:F
Credentials:LCSW, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:KAISER PERMANENETE 3280 E FOOTHILL BLVD 2ND FLOOR
Mailing Address - Street 2:PSYCHIATRY DEPT
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107
Mailing Address - Country:US
Mailing Address - Phone:626-583-3450
Mailing Address - Fax:
Practice Address - Street 1:3280 E FOOTHILL BLVD FL 2
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-3103
Practice Address - Country:US
Practice Address - Phone:626-583-3450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-06
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA823781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical