Healthcare Provider Details

I. General information

NPI: 1033508551
Provider Name (Legal Business Name): HYUNCHU KIM-GOLD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/21/2015
Last Update Date: 01/02/2025
Certification Date: 01/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E 77TH ST
NEW YORK NY
10075-1850
US

IV. Provider business mailing address

200 COMMUNITY DR
GREAT NECK NY
11021-5510
US

V. Phone/Fax

Practice location:
  • Phone: 212-434-2710
  • Fax:
Mailing address:
  • Phone: 212-434-2710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ15115100
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number339093
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number612489
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: