Healthcare Provider Details

I. General information

NPI: 1962624932
Provider Name (Legal Business Name): KENNETH K YIH L.C.S.W.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 MADISON AVE SUITE 1402
NEW YORK NY
10016
US

IV. Provider business mailing address

18 RICHARD DRIVE
SHORT HILLS NJ
07078-1325
US

V. Phone/Fax

Practice location:
  • Phone: 646-872-6126
  • Fax:
Mailing address:
  • Phone: 646-872-6126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number069942
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number44SC05322100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: