MEDICARE: KIM-HAN LORINE 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	103TC0700X	Clinical Psychologist	PSY22259	CA

General Provider Information

NPI Number	:	1144523820
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIM-HAN LORINE PHD

Provider Business Mailing Address
First Line	:	3466 STANBRIDGE AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90808-2650
Country	:	US
Telephone Number	:	310-308-1461
Fax Number	:

Provider Business Practice Location Address
First Line	:	3466 STANBRIDGE AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90808-2650
Country	:	US
Telephone Number	:	310-308-1461
Fax Number	:

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

Provider Enumeration Date	:	12/17/2010
Last Update Date	:	08/20/2021

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