Healthcare Provider Details

I. General information

NPI: 1588375232
Provider Name (Legal Business Name): WOOKSUN KIM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2022
Last Update Date: 09/17/2024
Certification Date: 09/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5410 N 44TH ST
TACOMA WA
98407-3715
US

IV. Provider business mailing address

5410 N 44TH ST
TACOMA WA
98407-3715
US

V. Phone/Fax

Practice location:
  • Phone: 253-759-9544
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: