NPI Code Detail JSON Logo

1083160790 NPI number — KIM KORY YOUNG M.HTECHICIAN/L.L.MSW

NPI Number: 1083160790
Health Care Provider/Practitioner: KIM KORY YOUNG M.HTECHICIAN/L.L.MSW

Information about “1083160790” NPI (KIM KORY YOUNG M.HTECHICIAN/L.L.MSW) exists in 1083160790 in HTML format HTML  |  1083160790 in plain Text format TXT  |  1083160790 in PDF (Portable Document Format) PDF  |  1083160790 in an XML format XML  formats.

NPI Number : 1083160790 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1083160790",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "YOUNG",
    "FirstName": "KIM",
    "MiddleName": "KORY",
    "NamePrefix": "MS.",
    "NameSuffix": null,
    "Credential": "M.HTECHICIAN/L.L.MSW",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "YOUNG",
    "OtherFirstName": "KIM",
    "OtherMiddleName": "K",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "116 N JOHNSON ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "PONTIAC",
    "MailingAddressStateName": "MI",
    "MailingAddressPostalCode": "48341",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "248-613-4098",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "116 N JOHNSON ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "PONTIAC",
    "PracticeLocationAddressStateName": "MI",
    "PracticeLocationAddressPostalCode": "48341-1330",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "248-613-4098",
    "PracticeLocationAddressFaxNumber": "248-622-4081",
    "EnumerationDate": "09/01/2016",
    "LastUpdateDate": "04/10/2020",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "101YA0400X",
          "TaxonomyName": "Addiction (Substance Use Disorder) Counselor",
          "LicenseNumber": "1-04781",
          "LicenseNumberStateCode": "MI",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "175T00000X",
          "TaxonomyName": "Peer Specialist",
          "LicenseNumber": null,
          "LicenseNumberStateCode": "MI",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "175T00000X",
          "TaxonomyName": "Peer Specialist",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "247200000X",
          "TaxonomyName": "Other Technician",
          "LicenseNumber": "L148347",
          "LicenseNumberStateCode": "MI",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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