Active NPI
Sun Mi Lee Kim
- Behavior Analyst
- Holmdel, NJ
National Provider Identifier
1720233992
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- License
- 11210520
- Practice address
- 14 Deercrest Dr
Holmdel, NJ 07733-1912 - Phone
- (732) 232-1023
- Fax
- (732) 367-5910
- NPI assigned
- Dec 1, 2008
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | SL009320 | PA | |
| Behavior Analyst | 103K00000X | 11210520 | NJ | Primary |
Addresses
Primary practice location
14 Deercrest Dr
Holmdel, NJ 07733-1912
Mailing address
14 Deercrest Dr
Holmdel, NJ 07733-1912
Phone (732) 232-1023
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 |
|---|---|---|---|
| 11210520 | NJ | MD | Behavioral Analyst |
| SL009320 | PA | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1228089600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1333497600000",
"number": "1720233992",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14 DEERCREST DR",
"city": "HOLMDEL",
"state": "NJ",
"postal_code": "077331912",
"telephone_number": "732-232-1023",
"fax_number": "732-367-5910"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14 DEERCREST DR",
"city": "HOLMDEL",
"state": "NJ",
"postal_code": "077331912",
"telephone_number": "732-232-1023",
"fax_number": "732-367-5910"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "SUN MI",
"middle_name": "LEE",
"name_prefix": "Mrs.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-12-01",
"last_updated": "2012-04-04",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "PA",
"license": "SL009320",
"primary": false
},
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "NJ",
"license": "11210520",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Holmdel, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.