Provider Demographics
NPI:1275970881
Name:KIM-PARK, YOOUSUN
Entity Type:Individual
Prefix:
First Name:YOOUSUN
Middle Name:
Last Name:KIM-PARK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1574 BELL BLVD # 210
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11360-1230
Mailing Address - Country:US
Mailing Address - Phone:425-312-4328
Mailing Address - Fax:
Practice Address - Street 1:1574 BELL BLVD # 210
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11360-1230
Practice Address - Country:US
Practice Address - Phone:425-312-4328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-23
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011621-01101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health