1780799379 NPI number — COLUMBA Y KIM MSW, L.C.S.W.

Table of content: COLUMBA Y KIM MSW, L.C.S.W. (NPI 1780799379)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780799379 NPI number — COLUMBA Y KIM MSW, L.C.S.W.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KIM
Provider First Name:
COLUMBA
Provider Middle Name:
Y
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSW, L.C.S.W.
Provider Gender Code:
F

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:
1780799379
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/18/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
763 17TH AVE.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN FRANCISCO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94121-3820
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
415-567-1678
Provider Business Mailing Address Fax Number:
415-386-4350

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1537 FRANKLIN ST.
Provider Second Line Business Practice Location Address:
SUITE 306
Provider Business Practice Location Address City Name:
SAN FRANCISCO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94109-4581
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
415-567-1678
Provider Business Practice Location Address Fax Number:
415-386-4350
Provider Enumeration Date:
08/21/2006

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:  LCS11978 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 80512 . This is a "SAN MATEO PROVIDER PIN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: CSW119780 . This is a "MEDICAL" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 06J8317 . This is a "CHAMPUS" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 217238 . This is a "MHN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 63666 . This is a "UNITED BEHAVIORAL HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7132079 . This is a "SAN FRANCISCO MENTAL HEAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 764178 . This is a "ALAMEDA PROVIDER ID" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: U204 . This is a "CITY HEALTH PLAN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 217238 . This is a "HEALTH NET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2301432 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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