MEDICARE: IRANG KIM MSW LCSW LCAS

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	C020081	NC
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	LCAS-27316	NC

General Provider Information

NPI Number	:	1598418444
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IRANG KIM MSW LCSW LCAS

Provider Business Mailing Address
First Line	:	7406 CHAPEL HILL RD STE J
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27607-5039
Country	:	US
Telephone Number	:	919-694-4361
Fax Number	:

Provider Business Practice Location Address
First Line	:	7406 CHAPEL HILL RD STE J
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27607-5039
Country	:	US
Telephone Number	:	262-373-8081
Fax Number	:	919-573-0438

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

Provider Enumeration Date	:	02/01/2022
Last Update Date	:	05/20/2026

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