Provider Demographics
NPI:1477353639
Name:KIM, CATHY SOYOUNG (CASE MANAGER)
Entity type:Individual
Prefix:
First Name:CATHY
Middle Name:SOYOUNG
Last Name:KIM
Suffix:
Gender:
Credentials:CASE MANAGER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 S LA FAYETTE PARK PL FL 3
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-1607
Mailing Address - Country:US
Mailing Address - Phone:213-252-2100
Mailing Address - Fax:
Practice Address - Street 1:520 S LA FAYETTE PARK PL FL 3
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-1607
Practice Address - Country:US
Practice Address - Phone:213-252-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-17
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA171M00000X, 172V00000X, 225400000X, 373H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No172V00000XOther Service ProvidersCommunity Health Worker
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner