| Doctor Name: | KIM WYNIA |
| NPI Number: | 1003168832 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MFTI, CAS II, FAC |
| License Number: | 01-043373 |
| Business Practice Address: | 1422 E Artesia Blvd Long Beach, CA - 908051619 |
| Business Phone Number: | 5627337186 |
| Business Fax Number: | |
| Mailing Address: | 1422 E Artesia Blvd, LONG BEACH |
| State: | CA |
| Postal Code: | 908051619 |
| Phone Number: | 5627337186 |
| Fax Number: | 5624230688 |
| NPI Enumeration Date: | 10/03/2012 |
| NPI Last Update Date: | 08/22/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 01-043373 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | CA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |