Provider Demographics
NPI:1083175467
Name:EUM, KOUN (PHD)
Entity Type:Individual
Prefix:DR
First Name:KOUN
Middle Name:
Last Name:EUM
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:JERICHO
Mailing Address - State:NY
Mailing Address - Zip Code:11753-2127
Mailing Address - Country:US
Mailing Address - Phone:516-719-6383
Mailing Address - Fax:
Practice Address - Street 1:500 N BROADWAY
Practice Address - Street 2:
Practice Address - City:JERICHO
Practice Address - State:NY
Practice Address - Zip Code:11753-2127
Practice Address - Country:US
Practice Address - Phone:516-719-6383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-27
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY02811-1103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty