Provider Demographics
NPI:1689130767
Name:KIM, EUNHYEONG
Entity Type:Individual
Prefix:MS
First Name:EUNHYEONG
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:EUNHYEONG
Other - Middle Name:LUCY
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:6011 39TH AVE APT 3E
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-2697
Mailing Address - Country:US
Mailing Address - Phone:929-459-0409
Mailing Address - Fax:
Practice Address - Street 1:6011 39TH AVE APT 3E
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-2697
Practice Address - Country:US
Practice Address - Phone:929-459-0409
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-14
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043077-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist