MEDICARE: MISS CHANYONG KIM CGC

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	170300000X	Genetic Counselor (M.S.)	GC002004	CA

General Provider Information

NPI Number	:	1619834389
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS CHANYONG KIM CGC

Provider Business Mailing Address
First Line	:	8723 ALDEN DR
Second Line	:	3RD FLOOR, ROOM 305
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-3692
Country	:	US
Telephone Number	:	424-315-1180
Fax Number	:

Provider Business Practice Location Address
First Line	:	8723 ALDEN DR
Second Line	:	3RD FLOOR, ROOM 305
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-3692
Country	:	US
Telephone Number	:	424-315-1180
Fax Number	:

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

Provider Enumeration Date	:	01/06/2026
Last Update Date	:	01/06/2026

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