Provider Demographics
NPI:1679546808
Name:KIM, MAY JUNG (PHD)
Entity Type:Individual
Prefix:DR
First Name:MAY
Middle Name:JUNG
Last Name:KIM
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7300 WYNDHAM DR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-4913
Mailing Address - Country:US
Mailing Address - Phone:916-525-6235
Mailing Address - Fax:
Practice Address - Street 1:7300 WYNDHAM DR
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-4913
Practice Address - Country:US
Practice Address - Phone:916-525-6235
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-08
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301012879103T00000X
CAPSY20999103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI11548989OtherCAQH CREDENTIALING