Provider Demographics
NPI:1871202077
Name:KIM, KWAN HONG (LMSW)
Entity type:Individual
Prefix:
First Name:KWAN HONG
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9406 34TH RD APT D1
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-6005
Mailing Address - Country:US
Mailing Address - Phone:201-615-9775
Mailing Address - Fax:
Practice Address - Street 1:2102 AVENUE Z STE 304
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-3084
Practice Address - Country:US
Practice Address - Phone:325-921-3250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-16
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker