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General NPI Number Information
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NPI Number | 1407369788
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Entity Type | Individual
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Provider Name | SOYON KIM
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Gender | Female
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Dates
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Enumeration Date | 11/09/2017
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Last Update Date | 11/09/2017
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Provider Practice Location Address
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Address Line | 1991 MARCUS AVE STE M201
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City | NEW HYDE PARK
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State | NY
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Zip | 11042-3000
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Country | US
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Telephone | 718-484-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 40 OAKWOOD ST
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City | GREENLAWN
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State | NY
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Zip | 11740-1422
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Country | US
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Telephone | 646-460-4742
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 308382
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License Number State | NY
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