Provider Demographics
NPI:1376668939
Name:KWON, KEUMBOON KATHERINE (MFT)
Entity Type:Individual
Prefix:
First Name:KEUMBOON
Middle Name:KATHERINE
Last Name:KWON
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5900 SEPULVEDA BLVD STE 425
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91411-2526
Mailing Address - Country:US
Mailing Address - Phone:818-267-1100
Mailing Address - Fax:818-267-1199
Practice Address - Street 1:5900 SEPULVEDA BLVD STE 425
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91411-2526
Practice Address - Country:US
Practice Address - Phone:818-267-1100
Practice Address - Fax:818-267-1199
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF46288106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist