Healthcare Provider Details

I. General information

NPI: 1235054784
Provider Name (Legal Business Name): JON KIM PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7300 SUNSET BLVD STE L PMB 1037
LOS ANGELES CA
90046
US

IV. Provider business mailing address

7300 W SUNSET BLVD STE L PMB 1037
LOS ANGELES CA
90046-3429
US

V. Phone/Fax

Practice location:
  • Phone: 213-293-6112
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number36891
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: