Organization
INNOBA, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MIKYEONG KIM LBA (DIRECTOR)
(718) 640-6550
Entity
Organization
Contact information
Practice address
5143 BELL BLVD, BAYSIDE HILLS, NY 11364-1225
(718) 640-6550
Mailing address
5143 BELL BLVD, BAYSIDE HILLS, NY 11364-1225
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
000632
NY
Other
Enumeration date
03/04/2015
Last updated
03/04/2015
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