MEDICARE: MICHELLE NAYOUNG KIM MSW

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	171M00000X	Case Manager/Care Coordinator	60670967	WA

General Provider Information

NPI Number	:	1780156992
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE NAYOUNG KIM MSW

Provider Business Mailing Address
First Line	:	515 3RD AVE OFC
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98104-2321
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1618 S LANE ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98144-2829
Country	:	US
Telephone Number	:	206-209-9336
Fax Number	:

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

Provider Enumeration Date	:	12/28/2018
Last Update Date	:	12/28/2018

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