Provider Demographics
NPI:1275393233
Name:JUNG HO KIM, MISUN CAROLYN
Entity Type:Individual
Prefix:
First Name:MISUN
Middle Name:CAROLYN
Last Name:JUNG HO KIM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9206 195TH STREET CT E
Mailing Address - Street 2:
Mailing Address - City:GRAHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98338-8476
Mailing Address - Country:US
Mailing Address - Phone:206-403-6781
Mailing Address - Fax:
Practice Address - Street 1:18407 PACIFIC AVE S STE 5
Practice Address - Street 2:
Practice Address - City:SPANAWAY
Practice Address - State:WA
Practice Address - Zip Code:98387-8374
Practice Address - Country:US
Practice Address - Phone:206-403-6781
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-19
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
WA101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No171M00000XOther Service ProvidersCase Manager/Care Coordinator