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NPI Code Detail

MEDICARE: MYUNGSU KIM

MEDICARE: MYUNGSU KIM
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101Y00000XCounselor
2101YP1600XPastoral Counselor
3101YP2500XProfessional CounselorIL
4101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1013623917
Entity Type Code : Individual
Provider Name (Legal Business Name) : MYUNGSU KIM
Provider Business Mailing Address
First Line : 305 N CENTER AVE
Second Line :
City : JEFFERSON
State : WI
Zip : 53549-1205
Country : US
Telephone Number : 415-867-7972
Fax Number :
Provider Business Practice Location Address
First Line : 30 N MICHIGAN AVE STE 1920
Second Line :
City : CHICAGO
State : IL
Zip : 60602-3618
Country : US
Telephone Number : 312-263-4368
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/25/2023
Last Update Date : 02/01/2023

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1750079935 — ANTHONY W SILKER LCSW, MSW, MA
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Directions to “ MYUNGSU KIM ” Practice Location

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