MEDICARE: SCOTT RICHARD KIM

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1801532197
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SCOTT RICHARD KIM

Provider Business Mailing Address
First Line	:	4322 E 7TH ST
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85711-2910
Country	:	US
Telephone Number	:	520-549-8297
Fax Number	:

Provider Business Practice Location Address
First Line	:	4322 E 7TH ST
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85711-2910
Country	:	US
Telephone Number	:	520-549-8297
Fax Number	:

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

Provider Enumeration Date	:	05/09/2022
Last Update Date	:	05/09/2022

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Directions to “ SCOTT RICHARD KIM ” Practice Location

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