MEDICARE: HYOJIN 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	235Z00000X	Speech-Language Pathologist
2	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1417704404
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HYOJIN KIM

Provider Business Mailing Address
First Line	:	10318 LAKE RD STE 102
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77070-1874
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10318 LAKE RD STE 102
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77070-1874
Country	:	US
Telephone Number	:	346-241-5473
Fax Number	:

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

Provider Enumeration Date	:	05/06/2024
Last Update Date	:	05/15/2024

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Directions to “ HYOJIN KIM ” Practice Location

Language	Start Address	Practice Location

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