Provider Demographics
NPI:1790815256
Name:KIM, YOUNGSHIN TERESA (MFT)
Entity Type:Individual
Prefix:MRS
First Name:YOUNGSHIN
Middle Name:TERESA
Last Name:KIM
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 ALEXIAN DR # 110
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95116-1901
Mailing Address - Country:US
Mailing Address - Phone:408-272-6594
Mailing Address - Fax:408-272-6569
Practice Address - Street 1:2101 ALEXIAN DR # 110
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-1901
Practice Address - Country:US
Practice Address - Phone:408-272-6594
Practice Address - Fax:408-272-6569
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 41757106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist