Healthcare Provider Details

I. General information

NPI: 1952290488
Provider Name (Legal Business Name): BO KUN SUSAN KIM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUSAN KIM

II. Dates (important events)

Enumeration Date: 06/30/2025
Last Update Date: 07/22/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

COMMUNITY YOUTH CENTER 1038 POST STREET
SAN FRANCISCO CA
94109
US

IV. Provider business mailing address

COMMUNITY YOUTH CENTER 1038 POST STREET
SAN FRANCISCO CA
94109
US

V. Phone/Fax

Practice location:
  • Phone: 415-775-2636
  • Fax:
Mailing address:
  • Phone: 415-775-2636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: