Provider Demographics
NPI:1780006221
Name:PAK, JINAH KIM (LCSW)
Entity Type:Individual
Prefix:
First Name:JINAH
Middle Name:KIM
Last Name:PAK
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 1:11050 ARTESIA BLVD STE F
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-2542
Mailing Address - Country:US
Mailing Address - Phone:562-860-8838
Mailing Address - Fax:213-383-3146
Practice Address - Street 1:11050 ARTESIA BLVD STE F
Practice Address - Street 2:
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-2542
Practice Address - Country:US
Practice Address - Phone:562-860-8838
Practice Address - Fax:213-383-3146
Is Sole Proprietor?:No
Enumeration Date:2014-01-17
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36711101YA0400X
CAASW36711101YM0800X
CA811881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health