Provider Demographics
NPI:1114517885
Name:KIM, JUNHYUNG NICOLAS (NP)
Entity Type:Individual
Prefix:
First Name:JUNHYUNG
Middle Name:NICOLAS
Last Name:KIM
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 MILLER BLVD
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-3510
Mailing Address - Country:US
Mailing Address - Phone:516-708-6351
Mailing Address - Fax:
Practice Address - Street 1:3825 PARSONS BLVD STE 1G
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-5839
Practice Address - Country:US
Practice Address - Phone:718-353-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-26
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY346877-01363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily