Provider Demographics
NPI:1952515579
Name:KIM, MARIA (MA)
Entity Type:Individual
Prefix:MS
First Name:MARIA
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2034 N HOOVER ST APT 3
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-2833
Mailing Address - Country:US
Mailing Address - Phone:323-304-8447
Mailing Address - Fax:
Practice Address - Street 1:680 S WILTON PL
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90005-3200
Practice Address - Country:US
Practice Address - Phone:213-365-7400
Practice Address - Fax:213-383-1280
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC44999106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist