MEDICARE: DR. JUNG YUN KIM PHD

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
1	103TA0700X	Adult Development & Aging Psychologist
2	103TC0700X	Clinical Psychologist	17994	CA
3	103TH0100X	Health Service Psychologist

General Provider Information

NPI Number	:	1063410397
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUNG YUN KIM PHD

Provider Business Mailing Address
First Line	:	6550 W OLYMPIC BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-5354
Country	:	US
Telephone Number	:	323-394-5164
Fax Number	:

Provider Business Practice Location Address
First Line	:	3540 WILSHIRE BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90010-2307
Country	:	US
Telephone Number	:	323-394-5164
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2005
Last Update Date	:	09/11/2025

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