MEDICARE: MINYOUNG KIM FNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	358769	NY

General Provider Information

NPI Number	:	1538015391
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MINYOUNG KIM FNP-BC

Provider Business Mailing Address
First Line	:	3420 32ND ST APT 1G
Second Line	:
City	:	ASTORIA
State	:	NY
Zip	:	11106-2776
Country	:	US
Telephone Number	:	347-571-7018
Fax Number	:

Provider Business Practice Location Address
First Line	:	3420 32ND ST APT 1G
Second Line	:
City	:	ASTORIA
State	:	NY
Zip	:	11106-2776
Country	:	US
Telephone Number	:	347-571-7018
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/05/2026
Last Update Date	:	03/05/2026

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Directions to “ MINYOUNG KIM FNP-BC” Practice Location

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