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General NPI Number Information
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NPI Number | 1811513005
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Entity Type | Individual
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Provider Name | CONSTANCE H KIM PA-C
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Gender | Female
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Dates
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Enumeration Date | 06/23/2020
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Last Update Date | 08/12/2020
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Provider Practice Location Address
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Address Line | 3096 51ST ST
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City | WOODSIDE
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State | NY
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Zip | 11377-1457
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Country | US
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Telephone | 718-204-1469
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Fax | 718-545-1726
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Provider Business Mailing Address
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Address Line | 232 MERRICK RD
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City | LYNBROOK
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State | NY
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Zip | 11563-2623
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Country | US
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Telephone | 516-594-5961
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Fax | 516-256-5556
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 025069
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License Number State | NY
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