Provider Demographics
NPI:1871074807
Name:KIM, MINJU (LH61111580)
Entity type:Individual
Prefix:
First Name:MINJU
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:LH61111580
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 112TH AVE NE STE 322E
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-2938
Mailing Address - Country:US
Mailing Address - Phone:425-372-8413
Mailing Address - Fax:
Practice Address - Street 1:1800 112TH AVE NE STE 322E
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-2938
Practice Address - Country:US
Practice Address - Phone:206-717-4477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-27
Last Update Date:2021-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC60794228101Y00000X
WALH61111580101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor