Provider Demographics
NPI:1740545193
Name:KIM, HYUN JEONG
Entity type:Individual
Prefix:
First Name:HYUN JEONG
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 1:601 W 110TH ST # 7J6
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-2186
Mailing Address - Country:US
Mailing Address - Phone:347-725-7360
Mailing Address - Fax:
Practice Address - Street 1:601 W 110TH STREET, #7J6
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-2186
Practice Address - Country:US
Practice Address - Phone:347-725-7360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-11
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY641495121252Y00000X
NY641494121252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency