Provider Demographics
NPI:1598095424
Name:KIM, YOUNG MI (ASW)
Entity Type:Individual
Prefix:MRS
First Name:YOUNG
Middle Name:MI
Last Name:KIM
Suffix:
Gender:F
Credentials:ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19819 SANTA ROSA DR
Mailing Address - Street 2:
Mailing Address - City:PORTER RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:91326-4164
Mailing Address - Country:US
Mailing Address - Phone:818-366-5919
Mailing Address - Fax:
Practice Address - Street 1:19819 SANTA ROSA DR
Practice Address - Street 2:
Practice Address - City:PORTER RANCH
Practice Address - State:CA
Practice Address - Zip Code:91326-4164
Practice Address - Country:US
Practice Address - Phone:818-366-5919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-26
Last Update Date:2009-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW 262391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA26239OtherBOARD OF BEHAVIORAL SCIENCES