Provider Demographics
NPI:1689967127
Name:SHIN, KYOUNGMI
Entity Type:Individual
Prefix:MRS
First Name:KYOUNGMI
Middle Name:
Last Name:SHIN
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 1:1665 W ADAMS BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90007-1533
Mailing Address - Country:US
Mailing Address - Phone:323-731-3534
Mailing Address - Fax:323-731-5618
Practice Address - Street 1:430 S FULLER AVE APT 6E
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90036-5362
Practice Address - Country:US
Practice Address - Phone:323-605-4346
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-17
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health