Provider Demographics
NPI:1083258073
Name:JASUNG KIM PSYCHIATRIST CLINIC, APC
Entity Type:Organization
Organization Name:JASUNG KIM PSYCHIATRIST CLINIC, APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JASUNG
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:213-797-5953
Mailing Address - Street 1:505 SHATTO PL
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90020-1754
Mailing Address - Country:US
Mailing Address - Phone:213-797-5953
Mailing Address - Fax:888-550-3121
Practice Address - Street 1:505 SHATTO PL STE 204
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90020-1777
Practice Address - Country:US
Practice Address - Phone:213-797-5953
Practice Address - Fax:888-550-3121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-01
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty