Provider Demographics
NPI:1275159857
Name:KIM, YOOBYUNG (LCSW)
Entity Type:Individual
Prefix:
First Name:YOOBYUNG
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:688 6TH STREET
Mailing Address - Street 2:
Mailing Address - City:FORT RICHARDSON
Mailing Address - State:AK
Mailing Address - Zip Code:99505
Mailing Address - Country:US
Mailing Address - Phone:907-384-0600
Mailing Address - Fax:
Practice Address - Street 1:688 6TH STREET
Practice Address - Street 2:
Practice Address - City:FORT RICHARDSON
Practice Address - State:AK
Practice Address - Zip Code:99505
Practice Address - Country:US
Practice Address - Phone:907-384-0600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-19
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0153311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical