Provider Demographics
NPI:1962806430
Name:DEO, KIM CHI NANG (LCSW)
Entity type:Individual
Prefix:MRS
First Name:KIM CHI
Middle Name:NANG
Last Name:DEO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17201 MIRASOL
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92620-0329
Mailing Address - Country:US
Mailing Address - Phone:714-908-6967
Mailing Address - Fax:
Practice Address - Street 1:17201 MIRASOL
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92620-0329
Practice Address - Country:US
Practice Address - Phone:714-908-6967
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-13
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW893211041C0700X
1041C0700X
CAASW62609101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical