Provider Demographics
NPI:1417537606
Name:KIM, MIKYUNG (LMHC)
Entity Type:Individual
Prefix:
First Name:MIKYUNG
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:13110 NE 177TH PL # 1083
Mailing Address - Street 2:
Mailing Address - City:WOODINVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98072-5740
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13110 NE 177TH PL # 1083
Practice Address - Street 2:
Practice Address - City:WOODINVILLE
Practice Address - State:WA
Practice Address - Zip Code:98072-5740
Practice Address - Country:US
Practice Address - Phone:425-616-3255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-12
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health