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General NPI Number Information
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NPI Number | 1194528901
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Entity Type | Organization
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Legal Business Name | NATIONAL MENTAL HEALTH PHYSICIAN ASSISTANT CORPORATION
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Dates
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Enumeration Date | 03/28/2025
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Last Update Date | 03/28/2025
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Provider Practice Location Address
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Address Line | 720 KNOLLWOOD LN
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City | SAN DIMAS
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State | CA
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Zip | 91773
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Country | US
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Telephone | 628-215-1120
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Fax |
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Provider Business Mailing Address
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Address Line | 720 KNOLLWOOD LN
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City | SAN DIMAS
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State | CA
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Zip | 91773-3617
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | YEON KIM
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Credential | PA-C
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Telephone | 628-215-1120
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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