MEDICARE: DR. MAY JUNG KIM PH.D.

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	103T00000X	Psychologist	6301012879	MI
2	103G00000X	Clinical Neuropsychologist	PSY20999	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	11548989	OTHER	MI	CAQH CREDENTIALING

General Provider Information

NPI Number	:	1679546808
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MAY JUNG KIM PH.D.

Provider Business Mailing Address
First Line	:	7300 WYNDHAM DR
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95823-4913
Country	:	US
Telephone Number	:	916-525-6235
Fax Number	:

Provider Business Practice Location Address
First Line	:	7300 WYNDHAM DR
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95823-4913
Country	:	US
Telephone Number	:	916-525-6235
Fax Number	:

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

Provider Enumeration Date	:	02/08/2006
Last Update Date	:	02/11/2022

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