Provider Demographics
NPI:1073865622
Name:KIM, SAONG YOUL (IMHT DR)
Entity type:Individual
Prefix:DR
First Name:SAONG YOUL
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:IMHT DR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3700 WILSHIRE BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-2903
Mailing Address - Country:US
Mailing Address - Phone:213-738-1131
Mailing Address - Fax:213-388-7168
Practice Address - Street 1:3700 WILSHIRE BLVD STE 200
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-2903
Practice Address - Country:US
Practice Address - Phone:213-738-1131
Practice Address - Fax:213-388-7168
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-05
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMHT 611-148103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical