MEDICARE: HAE SUK KIM

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	F355279-01	NY

General Provider Information

NPI Number	:	1659226165
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HAE SUK KIM

Provider Business Mailing Address
First Line	:	7210 37TH AVE APT 104
Second Line	:
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-6204
Country	:	US
Telephone Number	:	718-419-7996
Fax Number	:

Provider Business Practice Location Address
First Line	:	7210 37TH AVE APT 104
Second Line	:
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-6204
Country	:	US
Telephone Number	:	718-419-7996
Fax Number	:

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

Provider Enumeration Date	:	03/02/2026
Last Update Date	:	03/02/2026

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Directions to “ HAE SUK KIM ” Practice Location

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