Provider Demographics
NPI:1790404580
Name:KIM, HYUN JUN
Entity Type:Individual
Prefix:
First Name:HYUN JUN
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14945 NORTHERN BLVD APT 6K
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-3826
Mailing Address - Country:US
Mailing Address - Phone:857-210-5021
Mailing Address - Fax:
Practice Address - Street 1:15220 NORTHERN BLVD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-4951
Practice Address - Country:US
Practice Address - Phone:718-799-0800
Practice Address - Fax:718-799-0802
Is Sole Proprietor?:No
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY069367183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist