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General NPI Number Information
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NPI Number | 1134030737
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Entity Type | Individual
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Provider Name | STACEY YOON YOUNG KIM
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Gender | Female
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Dates
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Enumeration Date | 09/14/2026
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Last Update Date | 09/14/2026
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Provider Practice Location Address
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Address Line | 530 1ST AVE STE 9Q
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City | NEW YORK
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State | NY
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Zip | 10016-6402
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Country | US
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Telephone | 212-263-7225
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Fax |
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Provider Business Mailing Address
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Address Line | 340 E 23RD ST APT 4J
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City | NEW YORK
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State | NY
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Zip | 10010-4746
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Country | US
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Telephone | 516-680-8141
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Fax |
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | F360639-01
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License Number State | NY
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