Provider Demographics
NPI:1215458773
Name:KIM, SUZIE KYU (AAC)
Entity type:Individual
Prefix:
First Name:SUZIE
Middle Name:KYU
Last Name:KIM
Suffix:
Gender:F
Credentials:AAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8909 56TH PL W
Mailing Address - Street 2:
Mailing Address - City:MUKILTEO
Mailing Address - State:WA
Mailing Address - Zip Code:98275-3453
Mailing Address - Country:US
Mailing Address - Phone:206-280-2439
Mailing Address - Fax:
Practice Address - Street 1:10215 LAKE CITY WAY NE STE H
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-7758
Practice Address - Country:US
Practice Address - Phone:206-417-9904
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-05
Last Update Date:2017-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1114367521Medicaid