MEDICARE: HYUN KYU 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	101YA0400X	Addiction (Substance Use Disorder) Counselor	1904301100	CA

General Provider Information

NPI Number	:	1629156567
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HYUN KYU KIM

Provider Business Mailing Address
First Line	:	17027 1/4 CLARK AVE
Second Line	:
City	:	BELLFLOWER
State	:	CA
Zip	:	90706-5721
Country	:	US
Telephone Number	:	562-659-2030
Fax Number	:

Provider Business Practice Location Address
First Line	:	4416 BEVERLY BLVD.
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90004
Country	:	US
Telephone Number	:	323-668-9007
Fax Number	:

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

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	07/08/2007

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Directions to “ HYUN KYU KIM ” Practice Location

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