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General NPI Number Information
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NPI Number | 1013562891
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Entity Type | Individual
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Provider Name | HAKSOO KIM NURSE PRACTITIONER
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Gender | Female
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Dates
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Enumeration Date | 08/07/2019
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Last Update Date | 01/23/2026
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Provider Practice Location Address
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Address Line | 26 RESEARCH WAY
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City | EAST SETAUKET
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State | NY
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Zip | 11733-3526
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Country | US
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Telephone | 631-444-0502
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Fax | 631-444-0187
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Provider Business Mailing Address
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Address Line | 101 NICOLLS RD HSC, LEVEL 16, RM 80
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City | STONY BROOK
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State | NY
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Zip | 11794-8166
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Country | US
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Telephone | 631-444-1617
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Fax | 631-546-7004
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 309261
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License Number State | NY
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