Healthcare Provider Details

I. General information

NPI: 1528573474
Provider Name (Legal Business Name): HANNA KIM RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2017
Last Update Date: 12/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 BLEECKER ST
NEW YORK NY
10012-2413
US

IV. Provider business mailing address

26 BLEECKER ST
NEW YORK NY
10012-2413
US

V. Phone/Fax

Practice location:
  • Phone: 607-221-0363
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License Number676954
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: