MEDICARE: TAMARA 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	030536	NY

General Provider Information

NPI Number	:	1578148318
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMARA KIM

Provider Business Mailing Address
First Line	:	24235 BARROWS CT
Second Line	:
City	:	LITTLE NECK
State	:	NY
Zip	:	11362-1110
Country	:	US
Telephone Number	:	347-954-7988
Fax Number	:

Provider Business Practice Location Address
First Line	:	5311 SPRINGFIELD BLVD
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11364-1417
Country	:	US
Telephone Number	:	718-423-8652
Fax Number	:

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

Provider Enumeration Date	:	03/12/2021
Last Update Date	:	03/12/2021

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Directions to “ TAMARA KIM ” Practice Location

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