Provider Demographics
NPI:1760594949
Name:KIMURA, FAWN YURIKO (LCSW)
Entity Type:Individual
Prefix:MS
First Name:FAWN
Middle Name:YURIKO
Last Name:KIMURA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2099 S STATE COLLEGE BLVD STE 250
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92806-6134
Mailing Address - Country:US
Mailing Address - Phone:714-704-5900
Mailing Address - Fax:714-978-3419
Practice Address - Street 1:11251 KENSINGTON RD
Practice Address - Street 2:
Practice Address - City:ROSSMOOR
Practice Address - State:CA
Practice Address - Zip Code:90720-2908
Practice Address - Country:US
Practice Address - Phone:562-596-0783
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS110681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical