Provider Demographics
NPI:1063530806
Name:KIM, CAREY ANN (MSW)
Entity type:Individual
Prefix:MRS
First Name:CAREY
Middle Name:ANN
Last Name:KIM
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MS
Other - First Name:CAREY
Other - Middle Name:ANN
Other - Last Name:SEXTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW
Mailing Address - Street 1:7621 CANOGA AVE
Mailing Address - Street 2:
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91304-4912
Mailing Address - Country:US
Mailing Address - Phone:818-598-6900
Mailing Address - Fax:
Practice Address - Street 1:7621 CANOGA AVE.
Practice Address - Street 2:
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91304
Practice Address - Country:US
Practice Address - Phone:818-598-6900
Practice Address - Fax:818-598-6971
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW268861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1063530806Medicare UPIN