Provider Demographics
NPI:1780089185
Name:PROM, SINAE KIM
Entity type:Individual
Prefix:
First Name:SINAE
Middle Name:KIM
Last Name:PROM
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 1:3036 BRISTOL CREEK DR APT 201
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-7826
Mailing Address - Country:US
Mailing Address - Phone:336-905-9638
Mailing Address - Fax:
Practice Address - Street 1:3036 BRISTOL CREEK DR APT 201
Practice Address - Street 2:
Practice Address - City:MORRISVILLE
Practice Address - State:NC
Practice Address - Zip Code:27560-7826
Practice Address - Country:US
Practice Address - Phone:336-905-9638
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-28
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14029031235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist