Individual
BOMI KIM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
571 56TH ST APT 406, WEST NEW YORK, NJ 07093-8416
(847) 791-1354
Mailing address
571 56TH ST APT 406, WEST NEW YORK, NJ 07093-8416
(847) 791-1354
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14116064
ASHA
—
01
—
41YS00994500
NJ STATE LICENSE
NJ
Enumeration date
07/23/2019
Last updated
07/23/2019
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