Provider Demographics
NPI:1851144588
Name:KIM, BYUNGIL (PHD, LPCC)
Entity Type:Individual
Prefix:
First Name:BYUNGIL
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:PHD, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 WILDERNESS PL
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91766-6709
Mailing Address - Country:US
Mailing Address - Phone:585-402-1169
Mailing Address - Fax:
Practice Address - Street 1:16 WILDERNESS PL
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91766-6709
Practice Address - Country:US
Practice Address - Phone:585-402-1169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-11
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALPCC15656101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health