Provider Demographics
NPI:1457472730
Name:KIM, EUNAE CHRISTINA (PHD)
Entity Type:Individual
Prefix:DR
First Name:EUNAE
Middle Name:CHRISTINA
Last Name:KIM
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 1:1018 PALISADE AVE
Mailing Address - Street 2:APT # 3
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-6300
Mailing Address - Country:US
Mailing Address - Phone:718-578-5242
Mailing Address - Fax:
Practice Address - Street 1:21150 45TH DR
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-3357
Practice Address - Country:US
Practice Address - Phone:718-578-5242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001524101YM0800X
NY017463103T00000X
NJ35S100510500103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY017463OtherPSYCHOLOGIST
NY001524OtherMENTAL HEALTH
NJ35S100510500OtherPSYCHOLOGY LICENSE