Healthcare Provider Details

I. General information

NPI: 1588528392
Provider Name (Legal Business Name): NAYEON KIM
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 W 15TH ST
NEW YORK NY
10011-5903
US

IV. Provider business mailing address

325 W 15TH ST
NEW YORK NY
10011-5903
US

V. Phone/Fax

Practice location:
  • Phone: 212-604-6000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF311935
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: