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NPI Code Detail

MEDICARE: MYONG KIM LCSW

MEDICARE: MYONG KIM LCSW
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
1101YM0800XMental Health Counselor
2374700000XTechnician

General Provider Information

NPI Number : 1578604534
Entity Type Code : Individual
Provider Name (Legal Business Name) : MYONG KIM LCSW
Provider Business Mailing Address
First Line : 1816 3/4 SANTA YNEZ ST
Second Line :
City : LOS ANGELES
State : CA
Zip : 90026-4277
Country : US
Telephone Number : 818-640-7633
Fax Number :
Provider Business Practice Location Address
First Line : 1325 N WESTERN AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90027-5615
Country : US
Telephone Number : 323-957-7421
Fax Number : 323-463-3325
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/10/2007
Last Update Date : 03/22/2013

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Directions to “ MYONG KIM LCSW” Practice Location

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