Provider Demographics
NPI:1508037946
Name:KIM, HAEJA GRACE (MD,)
Entity Type:Individual
Prefix:DR
First Name:HAEJA
Middle Name:GRACE
Last Name:KIM
Suffix:
Gender:F
Credentials:MD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:92 ROGERS ST UNIT 4
Mailing Address - Street 2:
Mailing Address - City:BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06405-3665
Mailing Address - Country:US
Mailing Address - Phone:203-488-5817
Mailing Address - Fax:
Practice Address - Street 1:92 ROGERS ST UNIT 4
Practice Address - Street 2:
Practice Address - City:BRANFORD
Practice Address - State:CT
Practice Address - Zip Code:06405-3665
Practice Address - Country:US
Practice Address - Phone:203-488-5817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-13
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD034736L2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry