Healthcare Provider Details

I. General information

NPI: 1306762158
Provider Name (Legal Business Name): ELLEN JUNGHEE KIM LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

372 FALLINGSTAR
IRVINE CA
92614-7571
US

IV. Provider business mailing address

372 FALLINGSTAR
IRVINE CA
92614-7571
US

V. Phone/Fax

Practice location:
  • Phone: 714-305-3092
  • Fax:
Mailing address:
  • Phone: 714-305-3092
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number28714
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: