MEDICARE: MS. LUCY CHOI KIM LCSW

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	25048	CA

General Provider Information

NPI Number	:	1972095743
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LUCY CHOI KIM LCSW

Provider Business Mailing Address
First Line	:	136 S CLARK DR APT 4
Second Line	:
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90048-3253
Country	:	US
Telephone Number	:	310-936-6616
Fax Number	:

Provider Business Practice Location Address
First Line	:	415 N CAMDEN DR STE 117
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90210-4437
Country	:	US
Telephone Number	:	310-936-6616
Fax Number	:

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

Provider Enumeration Date	:	06/06/2018
Last Update Date	:	06/06/2018

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