Provider Demographics
NPI:1679767933
Name:KIM, EUNJEONG (APRN,BC)
Entity Type:Individual
Prefix:
First Name:EUNJEONG
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:APRN,BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:266 ROFF AVE UNIT A
Mailing Address - Street 2:
Mailing Address - City:PALISADES PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07650-1528
Mailing Address - Country:US
Mailing Address - Phone:201-562-8866
Mailing Address - Fax:
Practice Address - Street 1:ONE GUSTAVE L. LEVY PLACE, 1190 FIFTH AVE
Practice Address - Street 2:MOUNT SINAI HOSPITAL, CARDIAC DEPT,
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029
Practice Address - Country:US
Practice Address - Phone:212-241-6500
Practice Address - Fax:212-423-9488
Is Sole Proprietor?:No
Enumeration Date:2007-08-30
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF430330-1363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care