Provider Demographics
NPI:1780934364
Name:KIM, KYUNG-EUN (LL 60284713)
Entity type:Individual
Prefix:
First Name:KYUNG-EUN
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:LL 60284713
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29544 54TH CT S
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98001-3714
Mailing Address - Country:US
Mailing Address - Phone:253-835-6185
Mailing Address - Fax:
Practice Address - Street 1:33330 8TH AVE S
Practice Address - Street 2:FEDERAL WAY PUBLIC SCHOOLS (MIRROR LAKE ELEMENTARY)
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-6325
Practice Address - Country:US
Practice Address - Phone:253-945-3331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-11
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL 60284713235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist