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General NPI Number Information
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NPI Number | 1487774980
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Entity Type | Individual
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Provider Name | MI SUN KIM ANP
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Gender | Female
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Dates
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Enumeration Date | 03/29/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 525 E 68TH ST CARDIAC CATH LAB F439
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City | NEW YORK
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State | NY
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Zip | 10021-4870
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Country | US
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Telephone | 212-746-4644
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Fax |
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Provider Business Mailing Address
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Address Line | 1407 FRANKLIN AVE
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City | MAMARONECK
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State | NY
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Zip | 10543-2022
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Country | US
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Telephone | 914-777-0731
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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 | 304467
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License Number State | NY
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