Provider Demographics
NPI:1073936076
Name:KIM, DEBI (PHD)
Entity Type:Individual
Prefix:
First Name:DEBI
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1169 FAIRWAY DR
Mailing Address - Street 2:SUITE 205
Mailing Address - City:WALNUT
Mailing Address - State:CA
Mailing Address - Zip Code:91789-2847
Mailing Address - Country:US
Mailing Address - Phone:909-468-0900
Mailing Address - Fax:909-468-0911
Practice Address - Street 1:1169 FAIRWAY DR
Practice Address - Street 2:SUITE 205
Practice Address - City:WALNUT
Practice Address - State:CA
Practice Address - Zip Code:91789-2847
Practice Address - Country:US
Practice Address - Phone:909-468-0900
Practice Address - Fax:909-468-0911
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-27
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 37396106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist