Provider Demographics
NPI:1194895078
Name:KIM, CHRISTINE E (PHD)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:E
Last Name:KIM
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7342 ORANGETHORPE AVE
Mailing Address - Street 2:STE B121
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90621-4547
Mailing Address - Country:US
Mailing Address - Phone:562-445-4735
Mailing Address - Fax:562-296-4450
Practice Address - Street 1:7342 ORANGETHORPE AVE STE B111
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90621-4546
Practice Address - Country:US
Practice Address - Phone:562-445-4735
Practice Address - Fax:562-296-4450
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY25323103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical