Provider Demographics
NPI:1811267685
Name:KIM, GRACE YUJIN (MFTI)
Entity type:Individual
Prefix:MS
First Name:GRACE
Middle Name:YUJIN
Last Name:KIM
Suffix:
Gender:F
Credentials:MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6267 VARIEL AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-2512
Mailing Address - Country:US
Mailing Address - Phone:818-657-0411
Mailing Address - Fax:818-657-0506
Practice Address - Street 1:6267 VARIEL AVE
Practice Address - Street 2:SUITE B
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367-2512
Practice Address - Country:US
Practice Address - Phone:818-657-0411
Practice Address - Fax:818-657-0506
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-10
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF67570106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist