Provider Demographics
NPI:1083060818
Name:DR. AMY KIM PSYCHOTHERAPY, INC.
Entity Type:Organization
Organization Name:DR. AMY KIM PSYCHOTHERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:310-571-5605
Mailing Address - Street 1:11340 W OLYMPIC BLVD
Mailing Address - Street 2:350
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-1608
Mailing Address - Country:US
Mailing Address - Phone:310-571-5605
Mailing Address - Fax:
Practice Address - Street 1:11340 W OLYMPIC BLVD
Practice Address - Street 2:350
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-1608
Practice Address - Country:US
Practice Address - Phone:310-571-5605
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-11
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY28181103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty