MEDICARE: LINDA KIM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	2847647	NY

General Provider Information

NPI Number	:	1194491951
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDA KIM

Provider Business Mailing Address
First Line	:	3726 36TH ST APT 7A
Second Line	:
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11101-1630
Country	:	US
Telephone Number	:	714-599-3888
Fax Number	:

Provider Business Practice Location Address
First Line	:	3726 36TH ST APT 7A
Second Line	:
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11101-1630
Country	:	US
Telephone Number	:	714-599-3888
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/20/2021
Last Update Date	:	08/20/2021

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Directions to “ LINDA KIM ” Practice Location

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