Provider Demographics
NPI:1821296831
Name:KIM, HYUNYOUNG (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:HYUNYOUNG
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3545 WILSHIRE BLVD
Mailing Address - Street 2:SUIT #250
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-2354
Mailing Address - Country:US
Mailing Address - Phone:310-270-6001
Mailing Address - Fax:
Practice Address - Street 1:3545 WILSHIRE BLVD
Practice Address - Street 2:SUIT #250
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-2354
Practice Address - Country:US
Practice Address - Phone:310-270-6001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-11
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP14272235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist