Provider Demographics
NPI:1891315313
Name:KIM, MICHELLE Y
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:Y
Last Name:KIM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 53042
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92619-3042
Mailing Address - Country:US
Mailing Address - Phone:562-760-5812
Mailing Address - Fax:
Practice Address - Street 1:2501 E CHAPMAN AVE STE 106
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92831-3135
Practice Address - Country:US
Practice Address - Phone:949-229-5878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-24
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health