Healthcare Provider Details

I. General information

NPI: 1992567507
Provider Name (Legal Business Name): KIRIN KING LLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2024
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57239 N MAIN ST STE 1
THREE RIVERS MI
49093-9419
US

IV. Provider business mailing address

14970 HIDEAWAY RD
VANDALIA MI
49095-7706
US

V. Phone/Fax

Practice location:
  • Phone: 269-350-7385
  • Fax:
Mailing address:
  • Phone: 574-606-9117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6851117764
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: