Provider Demographics
NPI:1245576594
Name:KIM, HYE MI (EDM,BCBA)
Entity Type:Individual
Prefix:MS
First Name:HYE MI
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:EDM,BCBA
Other - Prefix:MS
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:EDM,BCBA
Mailing Address - Street 1:18726 S. WESTERN AVE.,#408
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90248
Mailing Address - Country:US
Mailing Address - Phone:310-856-0800
Mailing Address - Fax:310-324-3134
Practice Address - Street 1:18726 S. WESTERN AVE.,#408
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90248
Practice Address - Country:US
Practice Address - Phone:310-856-0800
Practice Address - Fax:310-324-3134
Is Sole Proprietor?:No
Enumeration Date:2012-12-13
Last Update Date:2013-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-11-9481103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst