Provider Demographics
NPI:1447401385
Name:KIM, JUNG-YOUNG (ANP)
Entity Type:Individual
Prefix:
First Name:JUNG-YOUNG
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:TRENT DR
Mailing Address - Street 2:047 BAKER HOUSE
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27710-0001
Mailing Address - Country:US
Mailing Address - Phone:919-681-1694
Mailing Address - Fax:919-684-6674
Practice Address - Street 1:TRENT DR
Practice Address - Street 2:047 BAKER HOUSE
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27710-0001
Practice Address - Country:US
Practice Address - Phone:919-681-1694
Practice Address - Fax:919-684-6674
Is Sole Proprietor?:No
Enumeration Date:2008-10-09
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5004060363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health