Active NPI
Yoousun Kim-Park
- Mental Health Counselor
- Bayside, NY
National Provider Identifier
1275970881
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 011621-01
- Practice address
- 1574 Bell Blvd # 210
Bayside, NY 11360-1230 - Phone
- (425) 312-4328
- NPI assigned
- May 23, 2013
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 011621-01 | NY | Primary |
Addresses
Primary practice location
1574 Bell Blvd # 210
Bayside, NY 11360-1230
Mailing address
1574 Bell Blvd # 210
Bayside, NY 11360-1230
Phone (425) 312-4328
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 011621-01 | NY | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1369267200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1711497600000",
"number": "1275970881",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1574 BELL BLVD # 210",
"city": "BAYSIDE",
"state": "NY",
"postal_code": "113601230",
"telephone_number": "425-312-4328"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1574 BELL BLVD # 210",
"city": "BAYSIDE",
"state": "NY",
"postal_code": "113601230",
"telephone_number": "425-312-4328"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM-PARK",
"first_name": "YOOUSUN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-05-23",
"last_updated": "2024-03-27",
"certification_date": "2024-03-27",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "NY",
"license": "011621-01",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bayside, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.