MEDICARE: JOSHUA W KIM B.A., M.S.W., A.S.W.

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	1041C0700X	Clinical Social Worker	100743	CA
2	101YM0800X	Mental Health Counselor	ASW71862	CA

General Provider Information

NPI Number	:	1235539792
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSHUA W KIM B.A., M.S.W., A.S.W.

Provider Business Mailing Address
First Line	:	3525 SAWTELLE BLVD APT 206
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90066-2954
Country	:	US
Telephone Number	:	424-388-5105
Fax Number	:

Provider Business Practice Location Address
First Line	:	3525 SAWTELLE BLVD APT 206
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90066-2954
Country	:	US
Telephone Number	:	424-388-5105
Fax Number	:

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

Provider Enumeration Date	:	09/02/2014
Last Update Date	:	07/14/2022

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