Provider Demographics
NPI:1205275815
Name:KIM, JINHEE CHRISTINE (LCSW)
Entity type:Individual
Prefix:
First Name:JINHEE
Middle Name:CHRISTINE
Last Name:KIM
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:PO BOX 14404
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-8404
Mailing Address - Country:US
Mailing Address - Phone:310-845-6155
Mailing Address - Fax:
Practice Address - Street 1:291 DEL AMO FASHION SQ UNIT 14404
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-9258
Practice Address - Country:US
Practice Address - Phone:310-845-6155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-17
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA856861041C0700X, 1041C0700X
CA61525101YM0800X
WACG60390989101YM0800X
225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner