Provider Demographics
NPI:1972042703
Name:KIM, JINRI
Entity Type:Individual
Prefix:
First Name:JINRI
Middle Name:
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 1:280 FORT WASHINGTON AVE
Mailing Address - Street 2:APT 66
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-1305
Mailing Address - Country:US
Mailing Address - Phone:562-237-0151
Mailing Address - Fax:
Practice Address - Street 1:8801 19TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-4684
Practice Address - Country:US
Practice Address - Phone:888-806-2497
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-13
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist