Provider Demographics
NPI:1629386438
Name:KIM, ERIN HAEJIN PARK
Entity Type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:HAEJIN PARK
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 1:1424 ELEGANTE CT
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92882-8037
Mailing Address - Country:US
Mailing Address - Phone:951-809-3007
Mailing Address - Fax:
Practice Address - Street 1:1424 ELEGANTE CT
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882-8037
Practice Address - Country:US
Practice Address - Phone:951-809-3007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-15
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health