Basic Information
| Provider Information | |||||||||
| NPI: | 1992351274 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KIM | ||||||||
| FirstName: | JYYEUN | ||||||||
| MiddleName: | HONG | ||||||||
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| Mailing Information | |||||||||
| Address1: | 21 ABETO | ||||||||
| Address2: | |||||||||
| City: | IRVINE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926201802 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9497058626 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3785 S PLAZA DR | ||||||||
| Address2: | |||||||||
| City: | SANTA ANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927047463 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7148282000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/13/2019 | ||||||||
| LastUpdateDate: | 08/13/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 114710 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.