Provider Demographics
NPI:1669480778
Name:KIM, ELIZABETH J (PHD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:J
Last Name:KIM
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:13030 EUCLID ST
Mailing Address - Street 2:STE 118
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-1334
Mailing Address - Country:US
Mailing Address - Phone:714-537-5400
Mailing Address - Fax:714-537-5465
Practice Address - Street 1:13030 EUCLID ST.
Practice Address - Street 2:STE 118
Practice Address - City:GARDENGROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-1334
Practice Address - Country:US
Practice Address - Phone:714-537-5400
Practice Address - Fax:714-537-5465
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 12964103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist