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General NPI Number Information
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NPI Number | 1891161741
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Entity Type | Individual
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Provider Name | KYONG OHK KIM
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Gender | Female
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Dates
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Enumeration Date | 08/14/2015
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Last Update Date | 06/23/2023
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Provider Practice Location Address
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Address Line | 2400 MOORPARK AVE # 3300
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City | SAN JOSE
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State | CA
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Zip | 95128-2631
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Country | US
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Telephone | 408-975-2745
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Fax |
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Provider Business Mailing Address
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Address Line | 2021 LOS GATOS ALMADEN RD
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City | SAN JOSE
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State | CA
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Zip | 95124-5456
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Country | US
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Telephone | 408-857-3242
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 93644
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License Number State | CA
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