MEDICARE: EUN LEE KIM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	26NJ00652700	NJ
2	363LF0000X	Family Nurse Practitioner	F337690	NY

General Provider Information

NPI Number	:	1528427432
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EUN LEE KIM

Provider Business Mailing Address
First Line	:	135 FORT LEE RD STE 101
Second Line	:
City	:	LEONIA
State	:	NJ
Zip	:	07605-2282
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	135 FORT LEE RD STE 101
Second Line	:
City	:	LEONIA
State	:	NJ
Zip	:	07605-2282
Country	:	US
Telephone Number	:	201-363-4645
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/19/2016
Last Update Date	:	09/20/2017

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Directions to “ EUN LEE KIM ” Practice Location

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