Provider Demographics
NPI:1851788970
Name:KIM, MIN YOUNG (NP)
Entity Type:Individual
Prefix:
First Name:MIN YOUNG
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 W 90TH ST
Mailing Address - Street 2:APARTMENT 11B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-1504
Mailing Address - Country:US
Mailing Address - Phone:718-813-7673
Mailing Address - Fax:
Practice Address - Street 1:34 PATTON BLVD
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-1731
Practice Address - Country:US
Practice Address - Phone:718-897-8915
Practice Address - Fax:718-424-4527
Is Sole Proprietor?:No
Enumeration Date:2015-04-16
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF339528-1363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care