Provider Demographics
NPI:1508256991
Name:KIM, GABRIELLA SUN-KYUNG (BSN, RN)
Entity Type:Individual
Prefix:MS
First Name:GABRIELLA
Middle Name:SUN-KYUNG
Last Name:KIM
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:1080 N DELAWARE AVE
Mailing Address - Street 2:SUITE 300D
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19125-4330
Mailing Address - Country:US
Mailing Address - Phone:215-287-2114
Mailing Address - Fax:267-773-4430
Practice Address - Street 1:1080 N DELAWARE AVE
Practice Address - Street 2:SUITE 300D
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19125-4330
Practice Address - Country:US
Practice Address - Phone:215-287-2114
Practice Address - Fax:267-773-4430
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-23
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PARN647187163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse