Provider Demographics
NPI:1598382087
Name:KIM, SAROM (LMSW (NY), ACSW (CA))
Entity Type:Individual
Prefix:
First Name:SAROM
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:LMSW (NY), ACSW (CA)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6718 BIANCA AVE
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91406-5342
Mailing Address - Country:US
Mailing Address - Phone:978-846-2248
Mailing Address - Fax:
Practice Address - Street 1:8737 VENICE BLVD STE 201
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90034-3258
Practice Address - Country:US
Practice Address - Phone:310-429-1986
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-30
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY109593104100000X
NY104100000X
CA1055941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker