Healthcare Provider Details

I. General information

NPI: 1205757606
Provider Name (Legal Business Name): SARAH JIWON KIM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 W 28TH ST STE 1402
NEW YORK NY
10001-6103
US

IV. Provider business mailing address

150 W 28TH ST STE 1402
NEW YORK NY
10001-6103
US

V. Phone/Fax

Practice location:
  • Phone: 917-830-5787
  • Fax:
Mailing address:
  • Phone: 917-830-5787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number05-P143411-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: