Provider Demographics
NPI:1972932366
Name:KIM, GAHYUN (MA)
Entity Type:Individual
Prefix:
First Name:GAHYUN
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:NAOMI
Other - Middle Name:
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA
Mailing Address - Street 1:88 GARDNER ST
Mailing Address - Street 2:APT 30
Mailing Address - City:ALLSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02134-2246
Mailing Address - Country:US
Mailing Address - Phone:503-715-7305
Mailing Address - Fax:
Practice Address - Street 1:88 GARDNER ST
Practice Address - Street 2:APT 30
Practice Address - City:ALLSTON
Practice Address - State:MA
Practice Address - Zip Code:02134-2246
Practice Address - Country:US
Practice Address - Phone:503-715-7305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-06
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health