Provider Demographics
NPI:1972905651
Name:KIM, KYUNGHEE (MA)
Entity type:Individual
Prefix:MS
First Name:KYUNGHEE
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MS
Other - First Name:KELLY
Other - Middle Name:
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA
Mailing Address - Street 1:792 WEST ST
Mailing Address - Street 2:APT F206
Mailing Address - City:MANSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02048-1184
Mailing Address - Country:US
Mailing Address - Phone:617-639-6730
Mailing Address - Fax:
Practice Address - Street 1:35 MCKONE ST APT 1
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02122
Practice Address - Country:US
Practice Address - Phone:617-412-9620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-24
Last Update Date:2018-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health