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NPI Code Detail

MEDICARE: MS. ELIZABETH KIM

MEDICARE: MS. ELIZABETH KIM
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor
2101YA0400XAddiction (Substance Use Disorder) Counselor
3390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1235463407
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. ELIZABETH KIM
Provider Business Mailing Address
First Line : 1100 CORPORATE CENTER DR
Second Line :
City : MONTEREY PARK
State : CA
Zip : 91754-7632
Country : US
Telephone Number : 323-768-2760
Fax Number :
Provider Business Practice Location Address
First Line : 7525 SE LAKE RD
Second Line :
City : MILWAUKIE
State : OR
Zip : 97267-2115
Country : US
Telephone Number : 503-238-0769
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/21/2009
Last Update Date : 02/25/2026

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