MEDICARE: ANGELA KIM MFTI

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	106H00000X	Marriage & Family Therapist	51875	CA

General Provider Information

NPI Number	:	1578712154
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA KIM MFTI

Provider Business Mailing Address
First Line	:	3517 CAMINITO SIERRA UNIT 102
Second Line	:
City	:	CARLSBAD
State	:	CA
Zip	:	92009-8654
Country	:	US
Telephone Number	:	310-922-2755
Fax Number	:

Provider Business Practice Location Address
First Line	:	3517 CAMINITO SIERRA UNIT 102
Second Line	:
City	:	CARLSBAD
State	:	CA
Zip	:	92009-8654
Country	:	US
Telephone Number	:	310-922-2755
Fax Number	:

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

Provider Enumeration Date	:	09/18/2008
Last Update Date	:	09/18/2008

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