Provider Demographics
NPI:1861898371
Name:KIM, JI-HYUN
Entity type:Individual
Prefix:
First Name:JI-HYUN
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JANE
Other - Middle Name:
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3727 W 6TH ST
Mailing Address - Street 2:STE. 411
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90020-5105
Mailing Address - Country:US
Mailing Address - Phone:213-365-7400
Mailing Address - Fax:213-201-3993
Practice Address - Street 1:3727 W 6TH ST
Practice Address - Street 2:SUITE 320
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90020-5105
Practice Address - Country:US
Practice Address - Phone:213-235-4863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-10
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 81363101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health