Provider Demographics
NPI:1568773851
Name:KIM, JULIA G (PHD)
Entity Type:Individual
Prefix:DR
First Name:JULIA
Middle Name:G
Last Name:KIM
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
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Mailing Address - Street 1:28800 RYAN RD
Mailing Address - Street 2:SUITE 320
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48092-4272
Mailing Address - Country:US
Mailing Address - Phone:586-582-0505
Mailing Address - Fax:586-620-8113
Practice Address - Street 1:28800 RYAN RD
Practice Address - Street 2:SUITE 320
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48092-4272
Practice Address - Country:US
Practice Address - Phone:586-582-0505
Practice Address - Fax:586-620-8113
Is Sole Proprietor?:No
Enumeration Date:2010-07-01
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI6301014979103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical