Healthcare Provider Details

I. General information

NPI: 1235539792
Provider Name (Legal Business Name): JOSHUA W KIM B.A., M.S.W., A.S.W.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2014
Last Update Date: 07/14/2022
Certification Date: 07/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3525 SAWTELLE BLVD APT 206
LOS ANGELES CA
90066-2954
US

IV. Provider business mailing address

3525 SAWTELLE BLVD APT 206
LOS ANGELES CA
90066-2954
US

V. Phone/Fax

Practice location:
  • Phone: 424-388-5105
  • Fax:
Mailing address:
  • Phone: 424-388-5105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberASW71862
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number100743
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: