Provider Demographics
NPI:1396432100
Name:KIM, HEEKYUNG (OT/L)
Entity type:Individual
Prefix:
First Name:HEEKYUNG
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:OT/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6333 E MOCKINGBIRD LN STE 147-2027
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75214-2692
Mailing Address - Country:US
Mailing Address - Phone:972-559-4594
Mailing Address - Fax:
Practice Address - Street 1:6333 E MOCKINGBIRD LN STE 147-2027
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75214-2692
Practice Address - Country:US
Practice Address - Phone:972-559-4594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-20
Last Update Date:2025-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23031225XP0200X
TX124249225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics