Provider Demographics
NPI:1003241191
Name:KIM, HAN SUNG
Entity Type:Individual
Prefix:MR
First Name:HAN
Middle Name:SUNG
Last Name:KIM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2103 TENAKILL PARK E
Mailing Address - Street 2:
Mailing Address - City:CRESSKILL
Mailing Address - State:NJ
Mailing Address - Zip Code:07626-2023
Mailing Address - Country:US
Mailing Address - Phone:201-674-8357
Mailing Address - Fax:
Practice Address - Street 1:2103 TENAKILL PARK E
Practice Address - Street 2:
Practice Address - City:CRESSKILL
Practice Address - State:NJ
Practice Address - Zip Code:07626-2023
Practice Address - Country:US
Practice Address - Phone:201-674-8357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-07
Last Update Date:2013-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023126-1235Z00000X
NJ41YS00740800235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist