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NPI Code Detail

MEDICARE: MRS. SALLIE CLARA KIM AMFT

MEDICARE: MRS. SALLIE CLARA KIM AMFT
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
1106H00000XMarriage & Family Therapist152617CA
2106H00000XMarriage & Family Therapist
3390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1699550897
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. SALLIE CLARA KIM AMFT
Provider Business Mailing Address
First Line : 14530 SYLVAN ST
Second Line :
City : VAN NUYS
State : CA
Zip : 91411-2324
Country : US
Telephone Number : 818-582-8832
Fax Number :
Provider Business Practice Location Address
First Line : 14530 SYLVAN ST
Second Line :
City : VAN NUYS
State : CA
Zip : 91411-2324
Country : US
Telephone Number : 818-582-8832
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/28/2023
Last Update Date : 03/30/2026

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Directions to “ MRS. SALLIE CLARA KIM AMFT” Practice Location

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