Provider Demographics
NPI:1942481122
Name:KIM, SORYOUNG ROSA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SORYOUNG
Middle Name:ROSA
Last Name:KIM
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 SOUTH 4TH ST.
Mailing Address - Street 2:SUITE 471
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19147
Mailing Address - Country:US
Mailing Address - Phone:267-861-3685
Mailing Address - Fax:215-965-1513
Practice Address - Street 1:525 SOUTH 4TH ST.
Practice Address - Street 2:SUITE 471
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19147
Practice Address - Country:US
Practice Address - Phone:267-861-3685
Practice Address - Fax:215-965-1513
Is Sole Proprietor?:No
Enumeration Date:2007-11-16
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS015583103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical