Provider Demographics
NPI:1942563234
Name:KIM, OTHILIA J
Entity type:Individual
Prefix:
First Name:OTHILIA
Middle Name:J
Last Name:KIM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 W 29TH ST
Mailing Address - Street 2:5TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-4504
Mailing Address - Country:US
Mailing Address - Phone:212-725-7850
Mailing Address - Fax:212-689-3212
Practice Address - Street 1:3 W 29TH ST
Practice Address - Street 2:5TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-4504
Practice Address - Country:US
Practice Address - Phone:212-725-7850
Practice Address - Fax:212-689-3212
Is Sole Proprietor?:No
Enumeration Date:2012-06-21
Last Update Date:2012-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP84358106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist