Provider Demographics
NPI:1134660111
Name:KIM, KO EUN (LCAT)
Entity Type:Individual
Prefix:
First Name:KO EUN
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4216 162ND ST APT 2
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11358-4155
Mailing Address - Country:US
Mailing Address - Phone:718-366-9540
Mailing Address - Fax:
Practice Address - Street 1:4216 162ND ST APT 2
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11358-4155
Practice Address - Country:US
Practice Address - Phone:718-366-9540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-10
Last Update Date:2019-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health