Provider Demographics
NPI:1750123931
Name:KIM, SOPHIA BROOKS
Entity type:Individual
Prefix:
First Name:SOPHIA
Middle Name:BROOKS
Last Name:KIM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9001 WILSHIRE BLVD STE 202
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-1841
Mailing Address - Country:US
Mailing Address - Phone:310-860-9502
Mailing Address - Fax:
Practice Address - Street 1:5550 TOPANGA CANYON BLVD STE 300
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367-7448
Practice Address - Country:US
Practice Address - Phone:818-918-2414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-10
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA136832106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist