Provider Demographics
NPI:1578604534
Name:KIM, MYONG (LCSW)
Entity Type:Individual
Prefix:
First Name:MYONG
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1816 3/4 SANTA YNEZ ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90026-4277
Mailing Address - Country:US
Mailing Address - Phone:818-640-7633
Mailing Address - Fax:
Practice Address - Street 1:1325 N WESTERN AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-5615
Practice Address - Country:US
Practice Address - Phone:323-957-7421
Practice Address - Fax:323-463-3325
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-10
Last Update Date:2013-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No374700000XNursing Service Related ProvidersTechnician