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General NPI Number Information
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NPI Number | 1215450077
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Entity Type | Individual
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Provider Name | LAUREN KIM-BAE PH.D., L.P.
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Gender | Female
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Dates
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Enumeration Date | 07/24/2017
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Last Update Date | 04/10/2019
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Provider Practice Location Address
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Address Line | 3200 HIGHWAY 100 S
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City | ST LOUIS PARK
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State | MN
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Zip | 55416-2175
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Country | US
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Telephone | 52-915-4251
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Fax | 952-920-2068
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Provider Business Mailing Address
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Address Line | 6425 NICOLLET AVE
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City | RICHFIELD
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State | MN
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Zip | 55423-1675
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Country | US
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Telephone | 612-798-8187
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | LP4302
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License Number State | MN
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