Healthcare Provider Details

I. General information

NPI: 1316660384
Provider Name (Legal Business Name): CHI SUK KIM FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2022
Last Update Date: 10/03/2023
Certification Date: 10/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4251 NORTHERN AVE
KANSAS CITY MO
64133-1593
US

IV. Provider business mailing address

4801 E LINWOOD BLVD
KANSAS CITY MO
64128-2226
US

V. Phone/Fax

Practice location:
  • Phone: 816-861-4700
  • Fax:
Mailing address:
  • Phone: 816-861-4700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA171588
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number2016021763
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: