Basic Information
| Provider Information | |||||||||
| NPI: | 1982720074 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KIM | ||||||||
| FirstName: | HWA | ||||||||
| MiddleName: | YOUNG ( JOSEPH ) | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1529 E PALMDALE BLVD STE 150 | ||||||||
| Address2: | |||||||||
| City: | PALMDALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 935502038 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6615751800 | ||||||||
| FaxNumber: | 6615372975 | ||||||||
| Practice Location | |||||||||
| Address1: | 1529 E. PALMDALE BLVE #150 | ||||||||
| Address2: | |||||||||
| City: | PALMDALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 93550 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6615751800 | ||||||||
| FaxNumber: | 6615372975 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/21/2007 | ||||||||
| LastUpdateDate: | 10/30/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | ASW18242 | CA | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | LCS26218 | CA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.