Provider Demographics
NPI:1407721814
Name:KIM, JEEHYUN
Entity type:Individual
Prefix:
First Name:JEEHYUN
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MIYA
Other - Middle Name:
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:7667 N WICKHAM RD APT 717
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-7934
Mailing Address - Country:US
Mailing Address - Phone:315-273-9582
Mailing Address - Fax:
Practice Address - Street 1:7667 N WICKHAM RD APT 717
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-7934
Practice Address - Country:US
Practice Address - Phone:315-273-9582
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-07
Last Update Date:2025-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician