Provider Demographics
NPI:1184929077
Name:KIM-ABIOG, KYUNGMI COLETTE (LCSW)
Entity type:Individual
Prefix:
First Name:KYUNGMI
Middle Name:COLETTE
Last Name:KIM-ABIOG
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:582 W STOCKER ST
Mailing Address - Street 2:6
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91202-2270
Mailing Address - Country:US
Mailing Address - Phone:818-240-1270
Mailing Address - Fax:
Practice Address - Street 1:582 W STOCKER ST
Practice Address - Street 2:6
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91202-2270
Practice Address - Country:US
Practice Address - Phone:818-240-1270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-24
Last Update Date:2014-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA185791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical