Provider Demographics
NPI:1457772378
Name:KIM, JONG HEE
Entity Type:Individual
Prefix:
First Name:JONG HEE
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 1:4015 61ST ST APT 7F
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-4924
Mailing Address - Country:US
Mailing Address - Phone:718-687-6109
Mailing Address - Fax:
Practice Address - Street 1:4015 61ST ST APT 7F
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-4924
Practice Address - Country:US
Practice Address - Phone:718-687-6109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-18
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY221700000221700000X
NY121361104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist