Healthcare Provider Details

I. General information

NPI: 1013301951
Provider Name (Legal Business Name): ANNA KIM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2015
Last Update Date: 08/29/2022
Certification Date: 08/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 LEXINGTON AVENUE, 12TH FL NORTHWELL BEHAVIORAL HEALTH
NEW YORK CITY NY
10022-6828
US

IV. Provider business mailing address

560 LEXINGTON AVE FL 12 NORTHWELL BEHAVIORAL HEALTH
NEW YORK NY
10022-6828
US

V. Phone/Fax

Practice location:
  • Phone: 646-665-6020
  • Fax:
Mailing address:
  • Phone: 646-665-6020
  • Fax: 646-665-6949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number285224
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2084P0015X
TaxonomyPsychosomatic Medicine Physician
License Number285224
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: