Provider Demographics
NPI:1255842035
Name:KIM, KYOUNGJUN (PHD)
Entity Type:Individual
Prefix:DR
First Name:KYOUNGJUN
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 ALICE ST APT A
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006-6820
Mailing Address - Country:US
Mailing Address - Phone:626-340-8105
Mailing Address - Fax:
Practice Address - Street 1:500 SHATTO PL STE 600
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90020-1789
Practice Address - Country:US
Practice Address - Phone:213-388-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-19
Last Update Date:2017-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist