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General NPI Number Information
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NPI Number | 1396124707
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Entity Type | Individual
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Provider Name | MYEONG JIN KIM PSY.D
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Gender | Female
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Dates
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Enumeration Date | 05/19/2015
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Last Update Date | 09/15/2020
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Provider Practice Location Address
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Address Line | 1745 BROADWAY FL 17
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City | NEW YORK
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State | NY
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Zip | 10019-4642
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Country | US
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Telephone | 212-851-8102
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Fax | 212-537-0102
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Provider Business Mailing Address
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Address Line | 475 48TH AVE APT 219
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City | LONG ISLAND CITY
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State | NY
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Zip | 11109-5503
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Country | US
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Telephone | 917-504-1606
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 021616
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 021616
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License Number State | NY
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