Provider Demographics
NPI:1427564418
Name:KIM, JUNG HYUN
Entity Type:Individual
Prefix:
First Name:JUNG HYUN
Middle Name:
Last Name: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 1:23801 SAPPHIRE CANYON RD
Mailing Address - Street 2:
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-1139
Mailing Address - Country:US
Mailing Address - Phone:909-217-2011
Mailing Address - Fax:
Practice Address - Street 1:23801 SAPPHIRE CANYON RD
Practice Address - Street 2:
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91765-1139
Practice Address - Country:US
Practice Address - Phone:909-217-2011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-28
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker