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General NPI Number Information
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NPI Number | 1780363200
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Entity Type | Individual
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Provider Name | GRACE S KIM NP
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Gender | Female
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Dates
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Enumeration Date | 07/12/2023
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Last Update Date | 09/18/2025
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Provider Practice Location Address
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Address Line | 276 5TH AVE RM 604
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City | NEW YORK
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State | NY
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Zip | 10001-4527
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Country | US
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Telephone | 332-239-1962
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Fax | 332-895-7542
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Provider Business Mailing Address
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Address Line | 924 QUINNIPIAC AVE APT 1
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City | NEW HAVEN
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State | CT
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Zip | 06513-3334
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Country | US
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Telephone |
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 12007
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 405554
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 26NJ15086700
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License Number State | NJ
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Taxonomy #4
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | APRN10000642
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License Number State | MA
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