Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 36472 | TX |
Y | 103TC0700X | Clinical Psychologist | 36472 | TX |
N | 103G00000X | Clinical Psychologist | 36472 | TX |
N | 103TC0700X | Clinical Psychologist | 36472 | TX |
N | 103TR0400X | Rehabilitation Psychologist | 36472 | TX |
NPI | 1609004472 |
---|---|
Provider Name | Heejin Kim |
First Address | Dallas, TX 75246-1713 |
Second Address | Dallas, TX 75246-1713 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2009 |
Last Update Date | 02/06/2014 |