Healthcare Provider Details

I. General information

NPI: 1205467826
Provider Name (Legal Business Name): ELIZABETH J. KIM, PH.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2020
Last Update Date: 06/27/2026
Certification Date: 06/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6131 ORANGETHORPE AVE STE D-260
BUENA PARK CA
90620-1315
US

IV. Provider business mailing address

3080 SAGE VIEW CT
FULLERTON CA
92833-5510
US

V. Phone/Fax

Practice location:
  • Phone: 213-268-6565
  • Fax:
Mailing address:
  • Phone: 213-268-6565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: DR. ELIZABETH J. KIM
Title or Position: PRESIDENT
Credential: PH.D.
Phone: 213-208-8190