Provider Demographics
NPI:1982347100
Name:KIM, JAE HYEON
Entity Type:Individual
Prefix:
First Name:JAE HYEON
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1835 W ORANGEWOOD AVE STE 323
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-2094
Mailing Address - Country:US
Mailing Address - Phone:714-929-1004
Mailing Address - Fax:
Practice Address - Street 1:1835 W ORANGEWOOD AVE STE 323
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-2094
Practice Address - Country:US
Practice Address - Phone:714-929-1004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-15
Last Update Date:2022-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician