Healthcare Provider Details

I. General information

NPI: 1386509289
Provider Name (Legal Business Name): MIN HI KIM NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2025
Last Update Date: 12/22/2025
Certification Date: 12/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19514 37TH AVE FL 2
FLUSHING NY
11358-4005
US

IV. Provider business mailing address

19514 37TH AVE FL 2
FLUSHING NY
11358-4005
US

V. Phone/Fax

Practice location:
  • Phone: 917-685-0004
  • Fax:
Mailing address:
  • Phone: 917-685-0004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberF312481-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: