Provider Demographics
NPI:1992090252
Name:KUM, KYUNGHAE (PSYD)
Entity type:Individual
Prefix:DR
First Name:KYUNGHAE
Middle Name:
Last Name:KUM
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8765 AERO DR
Mailing Address - Street 2:STE 228
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1785
Mailing Address - Country:US
Mailing Address - Phone:858-876-7779
Mailing Address - Fax:
Practice Address - Street 1:8765 AERO DR STE 228
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1785
Practice Address - Country:US
Practice Address - Phone:858-876-7779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-15
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health