1629933924 NPI number — PSYCHIATRIC BEHAVIORAL WELLNESS

Table of content: IN YEOP KIM MD, MPH (NPI 1760322754)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629933924 NPI number — PSYCHIATRIC BEHAVIORAL WELLNESS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PSYCHIATRIC BEHAVIORAL WELLNESS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1629933924
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/18/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3556 DARTMOUTH LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROWLAND HGHTS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91748-5136
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
562-304-5150
Provider Business Mailing Address Fax Number:
565-623-1710

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3556 DARTMOUTH LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROWLAND HGHTS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91748-5136
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-304-5150
Provider Business Practice Location Address Fax Number:
565-623-1710
Provider Enumeration Date:
12/18/2025

Additional Information

Authorized Official

Authorized Official Last Name:
TECHNOLOGIES
Authorized Official First Name:
REVMAX
Authorized Official Middle Name:
Authorized Official Title or Position:
ENROLLMENT MANAGER
Authorized Official Telephone Number:
720-784-9413

Provider Taxonomy Codes

  • Taxonomy code: 363LP0808X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2026 www.npivalidator.com