Provider Demographics
NPI:1720233992
Name:KIM, SUN MI LEE
Entity Type:Individual
Prefix:MRS
First Name:SUN MI
Middle Name:LEE
Last Name:KIM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 DEERCREST DR
Mailing Address - Street 2:
Mailing Address - City:HOLMDEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07733-1912
Mailing Address - Country:US
Mailing Address - Phone:732-232-1023
Mailing Address - Fax:732-367-5910
Practice Address - Street 1:14 DEERCREST DR
Practice Address - Street 2:
Practice Address - City:HOLMDEL
Practice Address - State:NJ
Practice Address - Zip Code:07733-1912
Practice Address - Country:US
Practice Address - Phone:732-232-1023
Practice Address - Fax:732-367-5910
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-01
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL009320235Z00000X
NJ11210520103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist