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General NPI Number Information
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NPI Number | 1215634712
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Entity Type | Individual
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Provider Name | MO SE KIM
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Gender | Male
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Dates
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Enumeration Date | 02/14/2023
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Last Update Date | 04/29/2025
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Provider Practice Location Address
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Address Line | 6930 BEACH BLVD UNIT L141
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City | BUENA PARK
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State | CA
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Zip | 90621-6856
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Country | US
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Telephone | 714-872-2291
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Fax |
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Provider Business Mailing Address
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Address Line | 6060 N PARAMOUNT BLVD
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City | LONG BEACH
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State | CA
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Zip | 90805-3711
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Country | US
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Telephone | 562-630-8672
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 5840
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 16606
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 16606
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License Number State | CA
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