Provider Demographics
NPI:1396386009
Name:KIM, ALEXANDRA MIKYUNG (RN)
Entity Type:Individual
Prefix:MS
First Name:ALEXANDRA
Middle Name:MIKYUNG
Last Name:KIM
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90-27 SUTPHIN BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11435
Mailing Address - Country:US
Mailing Address - Phone:718-830-4910
Mailing Address - Fax:718-830-4993
Practice Address - Street 1:90-27 SUTPHIN BOULEVARD
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11435
Practice Address - Country:US
Practice Address - Phone:718-830-4910
Practice Address - Fax:718-830-4993
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-03
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY440118-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse