Basic Information
| Provider Information | |||||||||
| NPI: | 1780006221 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PAK | ||||||||
| FirstName: | JINAH | ||||||||
| MiddleName: | KIM | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11050 ARTESIA BLVD STE F | ||||||||
| Address2: | |||||||||
| City: | CERRITOS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 907032542 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5628608838 | ||||||||
| FaxNumber: | 2133833146 | ||||||||
| Practice Location | |||||||||
| Address1: | 11050 ARTESIA BLVD STE F | ||||||||
| Address2: | |||||||||
| City: | CERRITOS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 907032542 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5628608838 | ||||||||
| FaxNumber: | 2133833146 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/17/2014 | ||||||||
| LastUpdateDate: | 12/12/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/12/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 36711 | CA | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YM0800X | ASW36711 | CA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 1041C0700X | 81188 | CA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.