MEDICARE: DR. MIJIN KIM L.C.A.T.

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	225A00000X	Music Therapist	000514	NY
2	101YP2500X	Professional Counselor	000514	NY

General Provider Information

NPI Number	:	1861612863
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MIJIN KIM L.C.A.T.

Provider Business Mailing Address
First Line	:	3446 CRESCENT ST FL 1.
Second Line	:
City	:	ASTORIA
State	:	NY
Zip	:	11106-3918
Country	:	US
Telephone Number	:	917-767-5237
Fax Number	:	718-519-4240

Provider Business Practice Location Address
First Line	:	98 RIVERSIDE DR STE 1A
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10024-5323
Country	:	US
Telephone Number	:	917-767-5237
Fax Number	:	718-519-4240

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

Provider Enumeration Date	:	05/01/2007
Last Update Date	:	11/14/2018

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