Provider Demographics
NPI:1104799527
Name:KIM, SUNG KYUNG (PPS)
Entity type:Individual
Prefix:
First Name:SUNG KYUNG
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:PPS
Other - Prefix:
Other - First Name:KRISTY
Other - Middle Name:
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1350 STARBUCK ST
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92833-5668
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1350 STARBUCK ST
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92833-5668
Practice Address - Country:US
Practice Address - Phone:714-447-2890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-24
Last Update Date:2025-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool