Basic Information
| Provider Information | |||||||||
| NPI: | 1679026363 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KIM | ||||||||
| FirstName: | HEEYOON | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3410 WOOSTER RD | ||||||||
| Address2: | 320 | ||||||||
| City: | ROCKY RIVER | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441164173 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2165134003 | ||||||||
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| Practice Location | |||||||||
| Address1: | 18101 LORAIN AVE | ||||||||
| Address2: | |||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441114173 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2164767029 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2016 | ||||||||
| LastUpdateDate: | 07/28/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.