Healthcare Provider Details

I. General information

NPI: 1114571882
Provider Name (Legal Business Name): MS. MINJUNG KIM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2019
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19742 MACARTHUR BOULEVARD SUITE 250
IRVINE CA
92612-2488
US

IV. Provider business mailing address

451 WEST LINCOLN AVENUE SUITE 100
ANAHEIM CA
92805-2912
US

V. Phone/Fax

Practice location:
  • Phone: 714-503-6550
  • Fax: 714-409-3075
Mailing address:
  • Phone: 714-503-6550
  • Fax: 714-409-3075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT163344
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number122710
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: