Provider Demographics
NPI:1568022341
Name:KIM, ROMINA
Entity Type:Individual
Prefix:
First Name:ROMINA
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 1:14228 26TH AVE W
Mailing Address - Street 2:UNIT A
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98087
Mailing Address - Country:US
Mailing Address - Phone:425-283-8297
Mailing Address - Fax:
Practice Address - Street 1:14228 26TH AVE W
Practice Address - Street 2:UNIT A
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98087
Practice Address - Country:US
Practice Address - Phone:425-283-8297
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-14
Last Update Date:2019-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst