Provider Demographics
NPI:1285942946
Name:KIM, EUN AH (MA, MFT)
Entity type:Individual
Prefix:
First Name:EUN AH
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2901 MOORPARK AVE STE 270
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-2557
Mailing Address - Country:US
Mailing Address - Phone:408-380-3008
Mailing Address - Fax:
Practice Address - Street 1:2901 MOORPARK AVE
Practice Address - Street 2:SUITE 270
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-2554
Practice Address - Country:US
Practice Address - Phone:408-380-3008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-15
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC48906106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALMFT48906OtherBOARD OF BEHAVIORAL SCIENCES
LMFT48906OtherCA