Provider Demographics
NPI:1235967308
Name:KIM, KATERINA (AUD, CCC-A)
Entity type:Individual
Prefix:
First Name:KATERINA
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:
Other - First Name:EKATERINA
Other - Middle Name:
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:260 AVENUE X
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-5940
Mailing Address - Country:US
Mailing Address - Phone:718-522-3399
Mailing Address - Fax:718-336-6479
Practice Address - Street 1:260 AVENUE X
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-5940
Practice Address - Country:US
Practice Address - Phone:718-522-3399
Practice Address - Fax:718-336-6479
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-22
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003246231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist