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NPI Code Detail

MEDICARE: SOO KIM MS

MEDICARE: SOO KIM MS
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
1103K00000XBehavior Analyst1-22-62832CA

General Provider Information

NPI Number : 1649736265
Entity Type Code : Individual
Provider Name (Legal Business Name) : SOO KIM MS
Provider Business Mailing Address
First Line : PO BOX 740780
Second Line :
City : ATLANTA
State : GA
Zip : 30374-0780
Country : US
Telephone Number : 855-223-7123
Fax Number : 619-374-7134
Provider Business Practice Location Address
First Line : 12465 LEWIS ST STE 102
Second Line :
City : GARDEN GROVE
State : CA
Zip : 92840-4658
Country : US
Telephone Number : 855-223-7123
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/19/2019
Last Update Date : 06/16/2026

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Directions to “ SOO KIM MS” Practice Location

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