Healthcare Provider Details

I. General information

NPI: 1073125522
Provider Name (Legal Business Name): ERIN DURI KIM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2020
Last Update Date: 08/03/2023
Certification Date: 08/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2677 N MAIN ST STE 110
SANTA ANA CA
92705-6663
US

IV. Provider business mailing address

PO BOX 741207
LOS ANGELES CA
90004-9207
US

V. Phone/Fax

Practice location:
  • Phone: 800-801-9833
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT119545
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT140011
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: