Provider Demographics
NPI:1093205676
Name:KIM, HONG
Entity type:Individual
Prefix:
First Name:HONG
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 PALISADE ST STE 396
Mailing Address - Street 2:
Mailing Address - City:DOBBS FERRY
Mailing Address - State:NY
Mailing Address - Zip Code:10522-1694
Mailing Address - Country:US
Mailing Address - Phone:201-969-5923
Mailing Address - Fax:212-202-7873
Practice Address - Street 1:145 PALISADE ST STE 396
Practice Address - Street 2:
Practice Address - City:DOBBS FERRY
Practice Address - State:NY
Practice Address - Zip Code:10522-1694
Practice Address - Country:US
Practice Address - Phone:201-969-5923
Practice Address - Fax:212-202-7873
Is Sole Proprietor?:No
Enumeration Date:2018-05-18
Last Update Date:2025-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01170200363LP0808X
NJ26NR18865500163WP0808X
CT166816163WP0808X
NY402766363LP0808X
NY711302163WH0200X
CT11875363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
9930425Other9930425