Provider Demographics
NPI:1821129909
Name:KONG, LIN MIN (MA, JD, LMFT)
Entity Type:Individual
Prefix:MS
First Name:LIN MIN
Middle Name:
Last Name:KONG
Suffix:
Gender:F
Credentials:MA, JD, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12510 VAN NUYS BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:PACOIMA
Mailing Address - State:CA
Mailing Address - Zip Code:91331-6732
Mailing Address - Country:US
Mailing Address - Phone:626-831-4266
Mailing Address - Fax:
Practice Address - Street 1:12510 VAN NUYS BLVD STE 201
Practice Address - Street 2:
Practice Address - City:PACOIMA
Practice Address - State:CA
Practice Address - Zip Code:91331-6732
Practice Address - Country:US
Practice Address - Phone:626-831-4266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2014-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53671106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist