MEDICARE: HEAJUNG KIM FNP

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	341817	NY

General Provider Information

NPI Number	:	1821728932
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEAJUNG KIM FNP

Provider Business Mailing Address
First Line	:	501 5TH AVE RM 1607
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10017-7856
Country	:	US
Telephone Number	:	212-481-1118
Fax Number	:	212-448-1049

Provider Business Practice Location Address
First Line	:	501 5TH AVE STE 1607
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10017-6107
Country	:	US
Telephone Number	:	212-481-1118
Fax Number	:	212-448-1049

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

Provider Enumeration Date	:	06/13/2022
Last Update Date	:	03/02/2026

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