Provider Demographics
NPI:1588828453
Name:LEE KIM, JIN (PHD)
Entity Type:Individual
Prefix:DR
First Name:JIN
Middle Name:
Last Name:LEE KIM
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:HYO JIN
Other - Middle Name:
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:4190 TELEGRAPH RD STE 2700
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-2042
Mailing Address - Country:US
Mailing Address - Phone:248-644-9466
Mailing Address - Fax:248-522-7365
Practice Address - Street 1:4190 TELEGRAPH RD STE 2700
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-2042
Practice Address - Country:US
Practice Address - Phone:248-644-9466
Practice Address - Fax:248-522-7365
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-10
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301013434103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist