Healthcare Provider Details

I. General information

NPI: 1609787613
Provider Name (Legal Business Name): LAURA HYO JIN KIM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5819 21ST AVE S
SEATTLE WA
98108-2988
US

IV. Provider business mailing address

5819 21ST AVE S
SEATTLE WA
98108-2988
US

V. Phone/Fax

Practice location:
  • Phone: 206-939-0992
  • Fax:
Mailing address:
  • Phone: 206-939-0992
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWIA.SC.70125707
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: