Provider Demographics
NPI:1508524778
Name:KIM, JAMES
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 S SAN TOMAS AQUINO RD APT 67
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-4433
Mailing Address - Country:US
Mailing Address - Phone:408-761-3762
Mailing Address - Fax:
Practice Address - Street 1:825 S SAN TOMAS AQUINO RD APT 67
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-4433
Practice Address - Country:US
Practice Address - Phone:408-761-3762
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-03
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health