Provider Demographics
NPI:1831337005
Name:KIM, ISABELLA EU KYUNG (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:ISABELLA
Middle Name:EU KYUNG
Last Name:KIM
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MRS
Other - First Name:ISABELLA
Other - Middle Name:EU KYUNG
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR/L
Mailing Address - Street 1:47 MADISON PLACE
Mailing Address - Street 2:
Mailing Address - City:ROSLYN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11577
Mailing Address - Country:US
Mailing Address - Phone:646-642-2244
Mailing Address - Fax:
Practice Address - Street 1:47 MADISON PLACE
Practice Address - Street 2:
Practice Address - City:ROSLYN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11577
Practice Address - Country:US
Practice Address - Phone:646-642-2244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-27
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012070-1171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor