MEDICARE: SOYEONG 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
1	104100000X	Social Worker
2	1041C0700X	Clinical Social Worker	136971	CA

General Provider Information

NPI Number	:	1568140317
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SOYEONG KIM

Provider Business Mailing Address
First Line	:	515 COLUMBIA AVE # 200
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90017-1209
Country	:	US
Telephone Number	:	714-580-9708
Fax Number	:	213-389-7993

Provider Business Practice Location Address
First Line	:	515 COLUMBIA AVE # 200
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90017-1209
Country	:	US
Telephone Number	:	213-249-9388
Fax Number	:	213-389-7993

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2023
Last Update Date	:	02/11/2026

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Directions to “ SOYEONG KIM ” Practice Location

Language	Start Address	Practice Location

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