Healthcare Provider Details

I. General information

NPI: 1659179588
Provider Name (Legal Business Name): DHAVIN KIM APCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2025
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7917 OSTROW ST STE A
SAN DIEGO CA
92111-3604
US

IV. Provider business mailing address

7917 OSTROW ST STE A
SAN DIEGO CA
92111-3604
US

V. Phone/Fax

Practice location:
  • Phone: 858-300-8282
  • Fax: 858-300-8284
Mailing address:
  • Phone: 858-300-8282
  • Fax: 858-300-8284

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number23066
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: