Provider Demographics
NPI:1083112551
Name:KIM, HYE MYUNG (RD)
Entity Type:Individual
Prefix:
First Name:HYE
Middle Name:MYUNG
Last Name:KIM
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:HYEMYUNG
Other - Middle Name:
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3716 80TH ST APT 31
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-6816
Mailing Address - Country:US
Mailing Address - Phone:201-724-3728
Mailing Address - Fax:
Practice Address - Street 1:297 KINDERKAMACK RD STE 202
Practice Address - Street 2:
Practice Address - City:ORADELL
Practice Address - State:NJ
Practice Address - Zip Code:07649-1535
Practice Address - Country:US
Practice Address - Phone:201-880-9400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-30
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No174N00000XOther Service ProvidersLactation Consultant, Non-RN