Provider Demographics
NPI:1750907598
Name:KIM, REBECCA HA KYUNG (SLP-CF, TSSLD)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:HA KYUNG
Last Name:KIM
Suffix:
Gender:F
Credentials:SLP-CF, TSSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 PARK ST
Mailing Address - Street 2:
Mailing Address - City:ROSELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:07068-1229
Mailing Address - Country:US
Mailing Address - Phone:201-566-4673
Mailing Address - Fax:
Practice Address - Street 1:622 3RD AVE FL 7
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-6723
Practice Address - Country:US
Practice Address - Phone:212-634-2803
Practice Address - Fax:646-650-5963
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-17
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1404845201390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program