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General NPI Number Information
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NPI Number | 1811016041
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Entity Type | Individual
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Provider Name | SU JUNG KIM LCSW
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Gender | Female
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Dates
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Enumeration Date | 03/28/2007
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Last Update Date | 05/02/2011
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Provider Practice Location Address
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Address Line | 550 S VERMONT AVE FL 10 OFFICE OF THE MEDICAL DIRECTOR, DEPT OF MENTAL HEALTH
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City | LOS ANGELES
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State | CA
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Zip | 90020-1912
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Country | US
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Telephone | 213-351-6033
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Fax | 213-738-4646
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Provider Business Mailing Address
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Address Line | 550 S VERMONT AVE FL 10 OFFICE OF THE MEDICAL DIRECTOR, DEPT OF MENTAL HEALTH
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City | LOS ANGELES
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State | CA
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Zip | 90020-1912
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Country | US
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Telephone | 213-351-6033
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Fax | 213-738-4646
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | ASW16674
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCS24510
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License Number State | CA
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