1255926663 NPI number — GIORGIANA ANGELICA KIM LLMSW

Table of content: GIORGIANA ANGELICA KIM LLMSW (NPI 1255926663)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255926663 NPI number — GIORGIANA ANGELICA KIM LLMSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KIM
Provider First Name:
GIORGIANA
Provider Middle Name:
ANGELICA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LLMSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KIM
Provider Other First Name:
ANGELICA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LLSMW
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1255926663
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/08/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1780 E GRAND RIVER AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EAST LANSING
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48823-4998
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
517-273-1484
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1780 E GRAND RIVER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST LANSING
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48823-4998
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-273-1484
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/08/2021

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  6801102312 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)