Provider Demographics
NPI:1083071716
Name:KIM, JOHN (MA MFT)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:MA MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 E DEL MAR BLVD APT 208
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-2738
Mailing Address - Country:US
Mailing Address - Phone:424-257-7394
Mailing Address - Fax:
Practice Address - Street 1:572 E GREEN ST STE 304
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-2085
Practice Address - Country:US
Practice Address - Phone:424-257-7394
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-26
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT105035106H00000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist