Provider Demographics
NPI:1780799379
Name:KIM, COLUMBA Y (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:COLUMBA
Middle Name:Y
Last Name:KIM
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:763 17TH AVE.
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94121-3820
Mailing Address - Country:US
Mailing Address - Phone:415-567-1678
Mailing Address - Fax:415-386-4350
Practice Address - Street 1:1537 FRANKLIN ST.
Practice Address - Street 2:SUITE 306
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-4581
Practice Address - Country:US
Practice Address - Phone:415-567-1678
Practice Address - Fax:415-386-4350
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS119781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA80512OtherSAN MATEO PROVIDER PIN
CACSW119780OtherMEDICAL
CA06J8317OtherCHAMPUS
217238OtherMHN
63666OtherUNITED BEHAVIORAL HEALTH
7132079OtherSAN FRANCISCO MENTAL HEAL
CA764178OtherALAMEDA PROVIDER ID
CAU204OtherCITY HEALTH PLAN
217238OtherHEALTH NET
CA2301432Medicaid
7132079OtherSAN FRANCISCO MENTAL HEAL
CA80512OtherSAN MATEO PROVIDER PIN