Provider Demographics
NPI:1598006553
Name:KIM, GEEEUN (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MS
First Name:GEEEUN
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:295 TENAFLY RD
Mailing Address - Street 2:APT #C
Mailing Address - City:TENAFLY
Mailing Address - State:NJ
Mailing Address - Zip Code:07670-2540
Mailing Address - Country:US
Mailing Address - Phone:201-981-5961
Mailing Address - Fax:
Practice Address - Street 1:295 TENAFLY RD
Practice Address - Street 2:APT #C
Practice Address - City:TENAFLY
Practice Address - State:NJ
Practice Address - Zip Code:07670-2540
Practice Address - Country:US
Practice Address - Phone:201-981-5961
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-14
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY624283163W00000X
NYF339239363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse