Provider Demographics
NPI:1477954907
Name:KIM, NAMSU (FNP)
Entity Type:Individual
Prefix:
First Name:NAMSU
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 REISS PL APT 5K
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-8060
Mailing Address - Country:US
Mailing Address - Phone:718-290-5055
Mailing Address - Fax:
Practice Address - Street 1:18 E BROADWAY
Practice Address - Street 2:ROOM 628
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002-6803
Practice Address - Country:US
Practice Address - Phone:212-226-6002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-16
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF338485-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily