Provider Demographics
NPI:1639794233
Name:BU, KYUNGSOOK (FNP)
Entity Type:Individual
Prefix:MS
First Name:KYUNGSOOK
Middle Name:
Last Name:BU
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 1:112 GREENMEADOW DR
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11729-5606
Mailing Address - Country:US
Mailing Address - Phone:212-767-9527
Mailing Address - Fax:
Practice Address - Street 1:10814 72ND AVE
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-7081
Practice Address - Country:US
Practice Address - Phone:718-520-8480
Practice Address - Fax:718-261-7886
Is Sole Proprietor?:No
Enumeration Date:2020-06-10
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF342887-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily