Provider Demographics
NPI:1114553625
Name:KIM, ISABEL S (MA)
Entity Type:Individual
Prefix:
First Name:ISABEL
Middle Name:S
Last Name:KIM
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:14605 SW OSPREY DR APT 1325
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97007-7967
Mailing Address - Country:US
Mailing Address - Phone:971-227-2133
Mailing Address - Fax:
Practice Address - Street 1:4035 NE SANDY BLVD STE 200
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97212-5331
Practice Address - Country:US
Practice Address - Phone:971-940-2601
Practice Address - Fax:971-275-1534
Is Sole Proprietor?:No
Enumeration Date:2020-03-16
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health