Provider Demographics
NPI:1174383814
Name:WU, ELENA EUN KYUNG KIM (PHD)
Entity type:Individual
Prefix:DR
First Name:ELENA
Middle Name:EUN KYUNG KIM
Last Name:WU
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:ELENA
Other - Middle Name:EUN KYUNG
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:2248 BROADWAY # 1263
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-5805
Mailing Address - Country:US
Mailing Address - Phone:347-377-0730
Mailing Address - Fax:
Practice Address - Street 1:46 W 83RD ST APT 7E
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-5253
Practice Address - Country:US
Practice Address - Phone:347-377-0730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-20
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026353103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty