Provider Demographics
NPI:1477814564
Name:KIM, JOE YOUNG (MSED)
Entity Type:Individual
Prefix:MR
First Name:JOE
Middle Name:YOUNG
Last Name:KIM
Suffix:
Gender:M
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8836 SABRE ST
Mailing Address - Street 2:
Mailing Address - City:QUEENS VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11427-2726
Mailing Address - Country:US
Mailing Address - Phone:347-229-5231
Mailing Address - Fax:
Practice Address - Street 1:8836 SABRE ST
Practice Address - Street 2:
Practice Address - City:QUEENS VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11427-2726
Practice Address - Country:US
Practice Address - Phone:347-229-5231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-05
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY669129103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst