Healthcare Provider Details

I. General information

NPI: 1912802950
Provider Name (Legal Business Name): KARREN KIM TRAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23511 VIA EL ROCIO
MISSION VIEJO CA
92691-3513
US

IV. Provider business mailing address

23511 VIA EL ROCIO
MISSION VIEJO CA
92691-3513
US

V. Phone/Fax

Practice location:
  • Phone: 562-912-5464
  • Fax:
Mailing address:
  • Phone: 562-912-5464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: