MEDICARE: DR. SUAH KIM PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	021429	NY

General Provider Information

NPI Number	:	1124427000
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUAH KIM PHD

Provider Business Mailing Address
First Line	:	329 E 62ND ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10065-7769
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	291 BROADWAY RM 709
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10007-1928
Country	:	US
Telephone Number	:	929-242-9970
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/18/2014
Last Update Date	:	10/03/2018

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