Individual
JEANNE KIM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSY.D.
Contact information
Practice address
21053 DEVONSHIRE ST, SUITE 101, CHATSWORTH, CA 91311-2364
(818) 726-5326
Mailing address
21053 DEVONSHIRE ST, SUITE 101, CHATSWORTH, CA 91311-2364
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
PSY22888
CA
103TA0700X
Adult Development & Aging Psychologist
PSY22888
CA
103TC0700X
Clinical Psychologist
PSY22888
CA
103TC2200X
Clinical Child & Adolescent Psychologist
PSY 22888
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PSY228880
—
CA
Enumeration date
12/17/2009
Last updated
09/20/2012
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