MEDICARE: MICHELLE KIM

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	235Z00000X	Speech-Language Pathologist	033737-01	NY

General Provider Information

NPI Number	:	1982463782
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE KIM

Provider Business Mailing Address
First Line	:	76 HAVEMEYER ST APT 4
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11211-3328
Country	:	US
Telephone Number	:	503-528-6463
Fax Number	:

Provider Business Practice Location Address
First Line	:	76 HAVEMEYER ST APT 4
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11211-3328
Country	:	US
Telephone Number	:	503-528-6463
Fax Number	:

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

Provider Enumeration Date	:	03/15/2024
Last Update Date	:	03/17/2024

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Directions to “ MICHELLE KIM ” Practice Location

Language	Start Address	Practice Location

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