Provider Demographics
NPI:1477906709
Name:KIM, HYOSUN (NP)
Entity Type:Individual
Prefix:
First Name:HYOSUN
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8701 56TH AVE
Mailing Address - Street 2:FL 1
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-4831
Mailing Address - Country:US
Mailing Address - Phone:718-457-0002
Mailing Address - Fax:718-457-9108
Practice Address - Street 1:3374 191ST ST
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11358-1940
Practice Address - Country:US
Practice Address - Phone:646-387-3419
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-21
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF3417371363LF0000X
NY7074021163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse