MEDICARE: EVA 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	363LP0200X	Pediatric Nurse Practitioner	383506	NY
2	363LP0200X	Pediatric Nurse Practitioner	26NJ01217100	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528721586
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EVA KIM

Provider Business Mailing Address
First Line	:	1430 BROADWAY
Second Line	:
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11106-4530
Country	:	US
Telephone Number	:	929-656-3407
Fax Number	:

Provider Business Practice Location Address
First Line	:	1430 BROADWAY
Second Line	:
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11106-4530
Country	:	US
Telephone Number	:	929-656-3407
Fax Number	:

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

Provider Enumeration Date	:	10/18/2021
Last Update Date	:	03/24/2026

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Directions to “ EVA KIM ” Practice Location

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