Healthcare Provider Details

I. General information

NPI: 1912688672
Provider Name (Legal Business Name): BOKYUNG KIM LCSW, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2023
Last Update Date: 07/26/2023
Certification Date: 07/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14415 41ST AVE
FLUSHING NY
11355-1445
US

IV. Provider business mailing address

14415 41ST AVE
FLUSHING NY
11355-1445
US

V. Phone/Fax

Practice location:
  • Phone: 929-279-2773
  • Fax:
Mailing address:
  • Phone: 929-279-2773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BOKYUNG KIM
Title or Position: PSYCHOTHERAPIST
Credential: LCSW
Phone: 929-279-2773