MEDICARE: DR. HONG SEON KIM PHD

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	103TC0700X	Clinical Psychologist	024589	NY
2	103T00000X	Psychologist

General Provider Information

NPI Number	:	1366135964
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HONG SEON KIM PHD

Provider Business Mailing Address
First Line	:	PO BOX 1225
Second Line	:
City	:	FORT LEE
State	:	NJ
Zip	:	07024-1225
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	137 E 25TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10010-2314
Country	:	US
Telephone Number	:	646-956-5575
Fax Number	:

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

Provider Enumeration Date	:	05/30/2023
Last Update Date	:	07/27/2023

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Directions to “ DR. HONG SEON KIM PHD” Practice Location

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