Provider Demographics
NPI:1952475543
Name:KIM, CINDY MIJUNG (MS, LICSW)
Entity Type:Individual
Prefix:MS
First Name:CINDY
Middle Name:MIJUNG
Last Name:KIM
Suffix:
Gender:F
Credentials:MS, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 M ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20001-4606
Mailing Address - Country:US
Mailing Address - Phone:202-347-5366
Mailing Address - Fax:202-628-3021
Practice Address - Street 1:450 M ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20001-4606
Practice Address - Country:US
Practice Address - Phone:202-347-5366
Practice Address - Fax:202-628-3021
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC500784361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical