MEDICARE: JENNIFER 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	101YM0800X	Mental Health Counselor
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1588111645
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER KIM

Provider Business Mailing Address
First Line	:	2717 ORCHARD AVE APT 21
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90007-7301
Country	:	US
Telephone Number	:	213-255-1306
Fax Number	:

Provider Business Practice Location Address
First Line	:	323 N SERRANO AVE APT A
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90004-2789
Country	:	US
Telephone Number	:	213-700-2408
Fax Number	:

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

Provider Enumeration Date	:	09/07/2016
Last Update Date	:	10/30/2018

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Directions to “ JENNIFER KIM ” Practice Location

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